Arquivo da tag: Epidemia

Com pandemia de covid-19, cartórios registram alta de 43% em mortes por causa indeterminada (Estadão)

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saude.estadao.com.br

Fabiana Cambricoli, 27 de abril de 2020

SÃO PAULO – Os cartórios brasileiros registraram alta de 43% no número de mortes por causa indeterminada notificadas no País desde o início da pandemia de covid-19 em território brasileiro. Os dados, antecipados pelo Estado, serão divulgados nesta segunda-feira, 27, em novo painel do Portal da Transparência do Registro Civil, mantido pela Associação Nacional dos Registradores de Pessoas Naturais (Arpen-Brasil). Segundo especialistas, o aumento de óbitos sem causa definida pode estar associado a vítimas de coronavírus que morreram sem ter o diagnóstico da doença.

A alta refere-se ao período de 26 de fevereiro, data em que o primeiro caso de infecção por coronavírus foi registrado no Brasil, até 17 de abril – como os cartórios tem até dez dias para repassar os registros para a Central de Informações do Registro Civil (CRC Nacional), a reportagem optou por um recorte até dez dias atrás.

Em 2020, o País teve 1.329 mortes por causa indeterminada no periodo mencionado. Em 2019, 925 óbitos do tipo foram registrados pelos cartórios no mesmo intervalo. De acordo com especialistas, o dado pode ser mais um indício de subnotificação do número de óbitos por coronavírus no País. Com a falta de testes e a alta demanda sobre o sistema de saúde em algumas regiões, doentes podem estar morrendo sem ter uma avaliação médica.

Para Fátima Marinho, professora da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG) e integrante do grupo de especialistas que auxiliou a Arpen-Brasil na elaboração do painel, é provável que o aumento de mortes por causa indefinida tenha como uma das razões a morte de pessoas por covid-19 que não tiveram acesso ao sistema de saúde. “Em uma situação de uma doença nova, uma pandemia, a gente espera um aumento de mortes em casa, sem que a pessoa sequer consiga ter atendimento médico. Isso pode estar acontecendo agora”, explica.

Se analisadas as mortes também por faixa etária, o aumento de óbitos por causa indeterminada é maior entre idosos, principal grupo de risco para complicações do coronavírus. O número de mortes sem causa definida entre pessoas com idade a partir de 60 anos passou de 568 em 2019 para 879 em 2020, alta de 54,8%. Já entre indivíduos com menos de 60 anos, a variação foi de 30,5% – subiu de 321 para 419 no mesmo intervalo de tempo.

Fátima diz que outra razão que pode estar impactando na alta de mortes por causas indeterminadas é o provável crescimento de óbitos por outras causas que não estão chegando aos hospitais pela dificuldade de conseguir leitos no meio da pandemia ou pelo eventual medo de pacientes em procurar unidades de saúde e se contaminarem. “Provavelmente teremos um aumento de mortes por infarto, AVC e outros problemas registrados em casa porque as pessoas estão adiando a ida ao pronto-socorro ou tendo que disputar leitos com pacientes com covid-19”, diz ela.

Salto em mortes por Síndrome Respiratória Aguda Grave

O portal da transparência mantido pela Arpen-Brasil também passa a disponibilizar o número de mortes por Síndrome Respiratória Aguda Grave (SRAG), que registrou aumento de 680% entre 26 de fevereiro e 17 de abril de 2019 e o mesmo período de 2020. Os números contemplam casos dessa condição respiratória em que não foi especificado o agente causador da síndrome, que pode ser coronavírus, mas também influenza ou outro vírus respiratório.

De acordo com o portal, o número de mortes do tipo passou de 156 para 1.217 no período citado. A alta nos óbitos por SRAG não especificada registradas em cartórios seriam outro indício de subnotificação. Ela é ainda maior em Estados com muitos casos da doença. No Amazonas, o aumento foi de 1.214%. No Ceará, de 3.828%. Em São Paulo, Estado com o maior número de infectados, o crescimento observado foi de 916%.

Outros dados anteriormente divulgados pela Arpen-Brasil mostravam indícios de que o número de mortes por coronavírus no Brasil pode ser maior que o computado oficialmente pelo Ministério da Saúde. Como revelou o Estado em 13 de abril, o número de registros de mortes por insuficiência respiratória e pneumonia no Brasil teve um salto em março, contrariando tendência de queda que vinha sendo observada nos meses de janeiro e fevereiro. Foram 2.239 mortes a mais em março de 2020 do que no mesmo período de 2019.

O número de mortes suspeitas ou confirmadas por covid-19 registradas nos cartórios também vem se mostrando maior do que as registradas pelo Ministério da Saúde (que considera só os óbitos confirmados por coronavírus). Na tarde desta segunda, por exemplo, os cartórios já registravam 4.839 vítimas com confirmação ou suspeita da doença. Já o Ministério contabilizava 4.543 registros.

Para Luis Carlos Vendramin Júnior, vice-presidente da Arpen-Brasil, a disponibilização dos dados dos cartórios ajudam a entender o avanço da epidemia. “Como temos esses dados com atualização diária, avaliamos que ampliar a transparência e divulgar dados também sobre mortes por SRAG e causas indeterminadas, além das que já vínhamos divulgando, vai auxiliar tanto o poder público quanto a imprensa e a população em geral na análise de números”, destacou.

We Still Don’t Know How the Coronavirus Is Killing Us (The Intelligencer)

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nymag.com

David Wallace-Wells, Apr. 26, 2020

Omar Rodriguez organizes bodies in the Gerard J. Neufeld funeral home in Elmhurst on April 22. Photo: Spencer Platt/Getty Images

Over the last few weeks, the country has managed to stabilize the spread of the coronavirus sufficiently enough to begin debating when and in what ways to “reopen,” and to normalize, against all moral logic, the horrifying and ongoing death toll — thousands of Americans dying each day, in multiples of 9/11 every week now with the virus seemingly “under control.” The death rate is no longer accelerating, but holding steady, which is apparently the point at which an onrushing terror can begin fading into background noise. Meanwhile, the disease itself appears to be shape-shifting before our eyes.

In an acute column published April 13, the New York Times’ Charlie Warzel listed 48 basic questions that remain unanswered about the coronavirus and what must be done to protect ourselves against it, from how deadly it is to how many people caught it and shrugged it off to how long immunity to the disease lasts after infection (if any time at all). “Despite the relentless, heroic work of doctors and scientists around the world,” he wrote, “there’s so much we don’t know.” The 48 questions he listed, he was careful to point out, did not represent a comprehensive list. And those are just the coronavirus’s “known unknowns.”

In the two weeks since, we’ve gotten some clarifying information on at least a handful of Warzel’s queries. In early trials, more patients taking the Trump-hyped hydroxychloroquinine died than those who didn’t, and the FDA has now issued a statement warning coronavirus patients and their doctors from using the drug. The World Health Organization got so worried about the much-touted antiviral remdesivir, which received a jolt of publicity (and stock appreciation) a few weeks ago on rumors of positive results, the organization leaked an unpublished, preliminary survey showing no benefit to COVID-19 patients. Globally, studies have consistently found exposure levels to the virus in most populations in the low single digits — meaning dozens of times more people have gotten the coronavirus than have been diagnosed with it, though still just a tiny fraction of the number needed to achieve herd immunity. In particular hot spots, the exposure has been significantly more widespread — one survey in New York City found that 21 percent of residents may have COVID-19 antibodies already, making the city not just the deadliest community in the deadliest country in a world during the deadliest pandemic since AIDS, but also the most infected (and, by corollary, the farthest along to herd immunity). A study in Chelsea, Massachusetts, found an even higher and therefore more encouraging figure: 32 percent of those tested were found to have antibodies, which would mean, at least in that area, the disease was only a fraction as severe as it might’ve seemed at first glance, and that the community as a whole could be as much as halfway along to herd immunity. In most of the rest of the country, the picture of exposure we now have is much more dire, with much more infection almost inevitably to come.

But there is one big question that didn’t even make it onto Warzel’s list that has only gotten more mysterious in the weeks since: How is COVID-19 actually killing us?

We are now almost six months into this pandemic, which began in November in Wuhan, with 50,000 Americans dead and 200,000 more around the world. If each of those deaths is a data point, together they represent a quite large body of evidence from which to form a clear picture of the pandemic threat. Early in the epidemic, the coronavirus was seen as a variant of a familiar family of disease, not a mysterious ailment, however infectious and concerning. But while uncertainties at the population level confuse and frustrate public-health officials, unsure when and in what form to shift gears out of lockdowns, the disease has proved just as mercurial at the clinical level, with doctors revising their understanding of COVID-19’s basic pattern and weaponry — indeed often revising that understanding in different directions at once. The clinical shape of the disease, long presumed to be a relatively predictable respiratory infection, is getting less clear by the week. Lately, it seems, by the day. As Carl Zimmer, probably the country’s most respected science journalist, asked virologists in a tweet last week, “is there any other virus out there that is this weird in terms of its range of symptoms?”

You probably have a sense of the range of common symptoms, and a sense that the range isn’t that weird: fever, dry cough, and shortness of breath have been, since the beginning of the outbreak, the familiar, oft-repeated group of tell-tale signs. But while the CDC does list fever as the top symptom of COVID-19, so confidently that for weeks patients were turned away from testing sites if they didn’t have an elevated temperature, according to the Journal of the American Medical Association, as many as 70 percent of patients sick enough to be admitted to New York State’s largest hospital system did not have a fever.

Over the past few months, Boston’s Brigham and Women’s Hospital has been compiling and revising, in real time, treatment guidelines for COVID-19 which have become a trusted clearinghouse of best-practices information for doctors throughout the country. According to those guidelines, as few as 44 percent of coronavirus patients presented with a fever (though, in their meta-analysis, the uncertainty is quite high, with a range of 44 to 94 percent). Cough is more common, according to Brigham and Women’s, with between 68 percent and 83 percent of patients presenting with some cough — though that means as many as three in ten sick enough to be hospitalized won’t be coughing. As for shortness of breath, the Brigham and Women’s estimate runs as low as 11 percent. The high end is only 40 percent, which would still mean that more patients hospitalized for COVID-19 do not have shortness of breath than do. At the low end of that range, shortness of breath would be roughly as common among COVID-19 patients as confusion (9 percent), headache (8 to 14 percent), and nausea and diarrhea (3 to 17 percent). That the ranges are so wide themselves tells you that the disease is presenting in very different ways in different hospitals and different populations of different patients — leading, for instance, some doctors and scientists to theorize the virus might be attacking the immune system like HIV does, with many others finding the disease is triggering something like the opposite response, an overwhelming overreaction of the immune system called a “cytokine storm.”

The most bedeviling confusion has arisen around the relationship of the disease to breathing, lung function, and oxygenation levels in the blood — typically, for a respiratory illness, a quite predictable relationship. But for weeks now, front-line doctors have been expressing confusion that so many coronavirus patients were registering lethally low blood-oxygenation levels while still appearing, by almost any vernacular measure, pretty okay. It’s one reason they’ve begun rethinking the initial clinical focus on ventilators, which are generally recommended when patients oxygenation falls below a certain level, but seemed, after a few weeks, of unclear benefit to COVID-19 patients, who may have done better, doctors began to suggest, on lesser or different forms of oxygen support. For a while, ventilators were seen so much as the essential tool in treating life-threatening coronavirus that shortages (and the president’s unwillingness to invoke the Defense Production Act to manufacture them quickly) became a scandal. But by one measure 88 percent of New York patients put on ventilators, for whom an outcome as known, had died. In China, the figure was 86 percent.

On April 20 in the New York Times, an ER doctor named Richard Levitan who had been volunteering at Bellevue proposed that the phenomenon of seemingly stable patients registering lethally low oxygen levels might be explained by “silent hypoxia” — the air sacs in the lung collapsing, not getting stiff or heavy with fluid, as is the case with the pneumonias doctors had been using as models in their treatment of COVID-19. But whether this explanation is universal, limited to the patients at Bellevue, or somewhere in between is not yet entirely clear. A couple of days later, in a pre-print paper others questioned, scientists reported finding that the ability of the disease to mutate has been “vastly underestimated” — investigating the disease as it appeared in just 11 patients, they said they found 30 mutations. “The most aggressive strains could generate 270 times as much viral load as the weakest type,” the South China Morning-Post reported. “These strains also killed the cells the fastest.”

That same day, the Washington Post reported on another theory gaining traction among American doctors treating the disease — that one key could be the way COVID-19 affects the blood of patients, producing much more clotting. “Autopsies have shown that some people’s lungs are filled with hundreds of microclots,” the Post reported. “Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or a heart attack.”

But the bigger-picture perspective the newspaper offered is perhaps more eye-opening and to the point:

One month ago, as the country went into lockdown to prepare for the first wave of coronavirus cases, many doctors felt confident that they knew what they were dealing with. Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a very contagious and lethal one with no vaccine and no treatment. But they’ve since become increasingly convinced that covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.

That is a dizzying list. But it is not even comprehensive. In a fantastic survey published April 17 (“How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes,” by Meredith Wadman, Jennifer Couzin-Frankel, Jocelyn Kaiser, and Catherine Matacic), Science magazine took a thorough, detailed tour of the ever-evolving state of understanding of the disease. “Despite the more than 1,000 papers now spilling into journals and onto preprint servers every week,” Science concluded, “a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen.”

In a single illuminating chart, Science lists the following organs as being vulnerable to COVID-19: brain, eyes, nose, lungs, heart, blood vessels, livers, kidneys, intestines. That is to say, nearly every organ:

And the disparate impacts were significant ones: Heart damage was discovered in 20 percent of patients hospitalized in Wuhan, where 44 percent of those in ICU exhibited arrhythmias; 38 percent of Dutch ICU patients had irregular blood clotting; 27 percent of Wuhan patients had kidney failure, with many more showing signs of kidney damage; half of Chinese patients showed signs of liver damage; and, depending on the study, between 20 percent and 50 percent of patients had diarrhea.

On April 15, the Washington Post reported that, in New York and Wuhan, between 14 and 30 percent of ICU patients had lost kidney function, requiring dialysis. New York hospitals were treating so much kidney failure “they need more personnel who can perform dialysis and have issued an urgent call for volunteers from other parts of the country. They also are running dangerously short of the sterile fluids used to deliver that therapy.” The result, the Post said, was rationed care: patients needing 24-hour support getting considerably less. On Saturday, the paper reported that “[y]oung and middle-aged people, barely sick with COVID-19, are dying from strokes.” Many of the patients described didn’t even know they were sick:

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head. Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

But the patient’s age wasn’t the only abnormality of the case:

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

These strokes, several doctors who spoke to the Post theorized, could explain the high number of patients dying at home — four times the usual rate in New York, many or most of them, perhaps, dying quite suddenly. According to the Brigham and Women’s guidelines, only 53 percent of COVID-19 patients have died from respiratory failure alone.

It’s not unheard of, of course, for a disease to express itself in complicated or hard-to-parse ways, attacking or undermining the functioning of a variety of organs. And it’s common, as researchers and doctors scramble to map the shape of a new disease, for their understanding to evolve quite quickly. But the degree to which doctors and scientists are, still, feeling their way, as though blindfolded, toward a true picture of the disease cautions against any sense that things have stabilized, given that our knowledge of the disease hasn’t even stabilized. Perhaps more importantly, it’s a reminder that the coronavirus pandemic is not just a public-health crisis but a scientific one as well. And that as deep as it may feel we are into the coronavirus, with tens of thousands dead and literally billions in precautionary lockdown, we are still in the very early stages, when each new finding seems as likely to cloud or complicate our understanding of the coronavirus as it is to clarify it. Instead, confidence gives way to uncertainty.

In the space of a few months, we’ve gone from thinking there was no “asymptomatic transmission” to believing it accounts for perhaps half or more of all cases, from thinking the young were invulnerable to thinking they were just somewhat less vulnerable, from believing masks were unnecessary to requiring their use at all times outside the house, from panicking about ventilator shortages to deploying pregnancy massage pillows instead. Six months since patient zero, we still have no drugs proven to even help treat the disease. Almost certainly, we are past the “Rare Cancer Seen in 41 Homosexuals” stage of this pandemic. But how far past?

Opinion | When Will Life Be Normal Again? We Just Don’t Know (The New York Times)

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nytimes.com

By Charlie Warzel, April 13, 2020

Many Americans have been living under lockdown for a month or more. We’re all getting antsy. The president is talking about a “light at the end of the tunnel.” People are looking for hope and reasons to plan a return to something — anything — approximating normalcy. Experts are starting to speculate on what lifting restrictions will look like. Despite the relentless, heroic work of doctors and scientists around the world, there’s so much we don’t know.

We don’t know how many people have been infected with Covid-19.

We don’t know the full range of symptoms.

We don’t always know why some infections develop into severe disease.

We don’t know the full range of risk factors.

We don’t know exactly how deadly the disease is.

We don’t have answers to more detailed questions about how the virus spreads, including: “How many virus particles does it even take to launch an infection? How far does the virus travel in outdoor spaces, or in indoor settings? Have these airborne movements affected the course of the pandemic?”

We don’t know for sure how this coronavirus first emerged.

We don’t know how much China has concealed the extent of the coronavirus outbreak in that country.

We don’t know what percentage of adults are asymptomatic. Or what percentage of children are asymptomatic.

We don’t know the strength and duration of immunity. Though people who recover from Covid-19 likely have some degree of immunity for some period of time, the specifics are unknown.

We don’t yet know why some who’ve been diagnosed as “fully recovered” from the virus have tested positive a second time after leaving quarantine.

We don’t know why some recovered patients have low levels of antibodies.

We don’t know the long-term health effects of a severe Covid-19 infection. What are the consequences to the lungs of those who survive intensive care?

We don’t yet know if any treatments are truly effective. While there are many therapies in trials, there are no clinically proven therapies aside from supportive care.

We don’t know for certain if the virus was in the United States before the first documented case.

We don’t know when supply chains will strengthen to provide health care workers with enough masks, gowns and face shields to protect them.

In America, we don’t know the full extent to which black people are disproportionately suffering. Fewer than a dozen states have published data on the race and ethnic patterns of Covid-19.

We don’t know if people will continue to adhere to social distancing guidelines once infections go down.

We don’t know when states will be able to test everyone who has symptoms.

We don’t know if the United States could ever deploy the number of tests — as many as 22 million per day — needed to implement mass testing and quarantining.

We don’t know if we can implement “test and trace” contact tracing at scale.

We don’t know whether smartphone location tracking could be implemented without destroying our privacy.

We don’t know if or when researchers will develop a successful vaccine.

We don’t know how many vaccines can be deployed and administered in the first months after a vaccine becomes available.

We don’t know how a vaccine will be administered — who will get it first?

We don’t know if a vaccine will be free or costly.

We don’t know if a vaccine will need to be updated every year.

We don’t know how, when we do open things up again, we will do it.

We don’t know if people will be afraid to gather in crowds.

We don’t know if people will be too eager to gather in crowds.

We don’t know what socially distanced professional sports will look like.

We don’t know what socially distanced workplaces will look like.

We don’t know what socially distanced bars and restaurants will look like.

We don’t know when schools will reopen.

We don’t know what a general election in a pandemic will look like.

We don’t know what effects lost school time will have on children.

We don’t know if the United States’s current and future government stimulus will stave off an economic collapse.

We don’t know whether the economy will bounce back in the form of a “v curve” …

Or whether it’ll be a long recession.

We don’t know when any of this will end for good.

There is, at present, no plan from the Trump White House on the way forward.

We’re working on a project about the ways people’s lives might be permanently altered by the coronavirus, even after the pandemic subsides. In what ways do you think your life will change in the long term? What will be your new “normal”?

‘Instead of Coronavirus, the Hunger Will Kill Us.’ A Global Food Crisis Looms (The New York Times)

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By Abdi Latif Dahir – April 22, 2020

The world has never faced a hunger emergency like this, experts say. It could double the number of people facing acute hunger to 265 million by the end of this year.

In Kibera, the largest slum in Nairobi, Kenya, residents already live in extreme poverty. Coronavirus lockdowns have caused many more to go hungry.
Credit…Tyler Hicks/The New York Times

Published April 22, 2020; Updated April 23, 2020, 6:39 a.m. ET

NAIROBI, Kenya — In the largest slum in Kenya’s capital, people desperate to eat set off a stampede during a recent giveaway of flour and cooking oil, leaving scores injured and two people dead.

In India, thousands of workers are lining up twice a day for bread and fried vegetables to keep hunger at bay.

And across Colombia, poor households are hanging red clothing and flags from their windows and balconies as a sign that they are hungry.

“We don’t have any money, and now we need to survive,” said Pauline Karushi, who lost her job at a jewelry business in Nairobi, and lives in two rooms with her child and four other relatives. “That means not eating much.”

The coronavirus pandemic has brought hunger to millions of people around the world. National lockdowns and social distancing measures are drying up work and incomes, and are likely to disrupt agricultural production and supply routes — leaving millions to worry how they will get enough to eat.

The coronavirus has sometimes been called an equalizer because it has sickened both rich and poor, but when it comes to food, the commonality ends. It is poor people, including large segments of poorer nations, who are now going hungry and facing the prospect of starving.

“The coronavirus has been anything but a great equalizer,” said Asha Jaffar, a volunteer who brought food to families in the Nairobi slum of Kibera after the fatal stampede. “It’s been the great revealer, pulling the curtain back on the class divide and exposing how deeply unequal this country is.”

Already, 135 million people had been facing acute food shortages, but now with the pandemic, 130 million more could go hungry in 2020, said Arif Husain, chief economist at the World Food Program, a United Nations agency. Altogether, an estimated 265 million people could be pushed to the brink of starvation by year’s end.

“We’ve never seen anything like this before,” Mr. Husain said. “It wasn’t a pretty picture to begin with, but this makes it truly unprecedented and uncharted territory.”

The world has experienced severe hunger crises before, but those were regional and caused by one factor or another — extreme weather, economic downturns, wars or political instability.

This hunger crisis, experts say, is global and caused by a multitude of factors linked to the coronavirus pandemic and the ensuing interruption of the economic order: the sudden loss in income for countless millions who were already living hand-to-mouth; the collapse in oil prices; widespread shortages of hard currency from tourism drying up; overseas workers not having earnings to send home; and ongoing problems like climate change, violence, population dislocations and humanitarian disasters.

Already, from Honduras to South Africa to India, protests and looting have broken out amid frustrations from lockdowns and worries about hunger. With classes shut down, over 368 million children have lost the nutritious meals and snacks they normally receive in school.

There is no shortage of food globally, or mass starvation from the pandemic — yet. But logistical problems in planting, harvesting and transporting food will leave poor countries exposed in the coming months, especially those reliant on imports, said Johan Swinnen, director general of the International Food Policy Research Institute in Washington.

While the system of food distribution and retailing in rich nations is organized and automated, he said, systems in developing countries are “labor intensive,” making “these supply chains much more vulnerable to Covid-19 and social distancing regulations.”

Yet even if there is no major surge in food prices, the food security situation for poor people is likely to deteriorate significantly worldwide. This is especially true for economies like Sudan and Zimbabwe that were struggling before the outbreak, or those like Iran that have increasingly used oil revenues to finance critical goods like food and medicine.

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In the sprawling Petare slum on the outskirts of the capital, Caracas, a nationwide lockdown has left Freddy Bastardo and five others in his household without jobs. Their government-supplied rations, which had arrived only once every two months before the crisis, have long run out.

“We are already thinking of selling things that we don’t use in the house to be able to eat,” said Mr. Bastardo, 25, a security guard. “I have neighbors who don’t have food, and I’m worried that if protests start, we wouldn’t be able to get out of here.”

As wages have dried up, half a million people are estimated to have left cities to walk home, setting off the nation’s “largest mass migration since independence,” said Amitabh Behar, the chief executive of Oxfam India.

On a recent evening, hundreds of migrant workers, who have been stuck in New Delhi after a lockdown was imposed in March with little warning, sat under the shade of a bridge waiting for food to arrive. The Delhi government has set up soup kitchens, yet workers like Nihal Singh go hungry as the throngs at these centers have increased in recent days.

“Instead of coronavirus, the hunger will kill us,” said Mr. Singh, who was hoping to eat his first meal in a day. Migrants waiting in food lines have fought each other over a plate of rice and lentils. Mr. Singh said he was ashamed to beg for food but had no other option.

“The lockdown has trampled on our dignity,” he said.

Refugees and people living in conflict zones are likely to be hit the hardest.

The curfews and restrictions on movement are already devastating the meager incomes of displaced people in Uganda and Ethiopia, the delivery of seeds and farming tools in South Sudan and the distribution of food aid in the Central African Republic. Containment measures in Niger, which hosts almost 60,000 refugees fleeing conflict in Mali, have led to surges in the pricing of food, according to the International Rescue Committee.

The effects of the restrictions “may cause more suffering than the disease itself,” said Kurt Tjossem, regional vice president for East Africa at the International Rescue Committee.

Ahmad Bayoush, a construction worker who had been displaced to Idlib Province in northern Syria, said he and many others had signed up to receive food from aid groups, but that it had yet to arrive.

“I am expecting real hunger if it continues like this in the north,” he said.

The pandemic is also slowing efforts to deal with the historic locust plague that has been ravaging the East and Horn of Africa. The outbreak is the worst the region has seen in decades and comes on the heels of a year marked by extreme droughts and floods. But the arrival of billions of new swarms could further deepen food insecurity, said Cyril Ferrand, head of the Food and Agriculture Organization’s resilience team in eastern Africa.

Travel bans and airport closures, Mr. Ferrand said, are interrupting the supply of pesticides that could help limit the locust population and save pastureland and crops.

As many go hungry, there is concern in a number of countries that food shortages will lead to social discord. In Colombia, residents of the coastal state of La Guajira have begun blocking roads to call attention to their need for food. In South Africa, rioters have broken into neighborhood food kiosks and faced off with the police.

And even charitable food giveaways can expose people to the virus when throngs appear, as happened in Nairobi’s shantytown of Kibera earlier this month.

“People called each other and came rushing,” said Valentine Akinyi, who works at the district government office where the food was distributed. “People have lost jobs. It showed you how hungry they are.”

Yet communities across the world are also taking matters into their own hands. Some are raising money through crowdfunding platforms, while others have begun programs to buy meals for needy families.

On a recent afternoon, Ms. Jaffar and a group of volunteers made their way through Kibera, bringing items like sugar, flour, rice and sanitary pads to dozens of families. A native of the area herself, Ms. Jaffar said she started the food drive after hearing so many stories from families who said they and their children were going to sleep hungry.

The food drive has so far reached 500 families. But with all the calls for assistance she’s getting, she said, “that’s a drop in the ocean.”

Reporting was contributed by Anatoly Kurmanaev and Isayen Herrera from Caracas, Venezuela; Paulina Villegas from Mexico City; Julie Turkewitz from Bogotá, Colombia; Ben Hubbard and Hwaida Saad from Beirut, Lebanon; Sameer Yasir from New Delhi; and Hannah Beech from Bangkok.

The Pandemic Isn’t a Black Swan but a Portent of a More Fragile Global System (New Yorker)

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newyorker.com

Bernard Avishai – April 21, 2020

Nassim Nicholas Taleb at his home in Larchmont N.Y.
Nassim Nicholas Taleb says that his profession is “probability.” But his vocation is showing how the unpredictable is increasingly probable.Photograph Michael Appleton / NYT / Redux

Nassim Nicholas Taleb is “irritated,” he told Bloomberg Television on March 31st, whenever the coronavirus pandemic is referred to as a “black swan,” the term he coined for an unpredictable, rare, catastrophic event, in his best-selling 2007 book of that title. “The Black Swan” was meant to explain why, in a networked world, we need to change business practices and social norms—not, as he recently told me, to provide “a cliché for any bad thing that surprises us.” Besides, the pandemic was wholly predictable—he, like Bill Gates, Laurie Garrett, and others, had predicted it—a white swan if ever there was one. “We issued our warning that, effectively, you should kill it in the egg,” Taleb told Bloomberg. Governments “did not want to spend pennies in January; now they are going to spend trillions.”

The warning that he referred to appeared in a January 26th paper that he co-authored with Joseph Norman and Yaneer Bar-Yam, when the virus was still mainly confined to China. The paper cautions that, owing to “increased connectivity,” the spread will be “nonlinear”—two key contributors to Taleb’s anxiety. For statisticians, “nonlinearity” describes events very much like a pandemic: an output disproportionate to known inputs (the structure and growth of pathogens, say), owing to both unknown and unknowable inputs (their incubation periods in humans, or random mutations), or eccentric interaction among various inputs (wet markets and airplane travel), or exponential growth (from networked human contact), or all three.

“These are ruin problems,” the paper states, exposure to which “leads to a certain eventual extinction.” The authors call for “drastically pruning contact networks,” and other measures that we now associate with sheltering in place and social distancing. “Decision-makers must act swiftly,” the authors conclude, “and avoid the fallacy that to have an appropriate respect for uncertainty in the face of possible irreversible catastrophe amounts to ‘paranoia.’ ” (“Had we used masks then”—in late January—“we could have saved ourselves the stimulus,” Taleb told me.)

Yet, for anyone who knows his work, Taleb’s irritation may seem a little forced. His profession, he says, is “probability.” But his vocation is showing how the unpredictable is increasingly probable. If he was right about the spread of this pandemic it’s because he has been so alert to the dangers of connectivity and nonlinearity more generally, to pandemics and other chance calamities for which COVID-19 is a storm signal. “I keep getting asked for a list of the next four black swans,” Taleb told me, and that misses his point entirely. In a way, focussing on his January warning distracts us from his main aim, which is building political structures so that societies will be better able to cope with mounting, random events.

Indeed, if Taleb is chronically irritated, it is by those economists, officials, journalists, and executives—the “naïve empiricists”—who think that our tomorrows are likely to be pretty much like our yesterdays. He explained in a conversation that these are the people who, consulting bell curves, focus on their bulging centers, and disregard potentially fatal “fat tails”—events that seem “statistically remote” but “contribute most to outcomes,” by precipitating chain reactions, say. (Last week, Dr. Phil told Fox’s Laura Ingraham that we should open up the country again, noting, wrongly, that “three hundred and sixty thousand people die each year “from swimming pools — but we don’t shut the country down for that.” In response, Taleb tweeted, “Drowning in swimming pools is extremely contagious and multiplicative.”) Naïve empiricists plant us, he argued in “The Black Swan,” in “Mediocristan.” We actually live in “Extremistan.”

Taleb, who is sixty-one, came by this impatience honestly. As a young man, he lived through Lebanon’s civil war, which was precipitated by Palestinian militias escaping a Jordanian crackdown, in 1971, and led to bloody clashes between Maronite Christians and Sunni Muslims, drawing in Shiites, Druze, and the Syrians as well. The conflict lasted fifteen years and left some ninety thousand people dead. “These events were unexplainable, but intelligent people thought they were capable of providing convincing explanations for them—after the fact,” Taleb writes in “The Black Swan.” “The more intelligent the person, the better sounding the explanation.” But how could anyone have anticipated “that people who seemed a model of tolerance could become the purest of barbarians overnight?” Given the prior cruelties of the twentieth century, the question may sound ingenuous, but Taleb experienced sudden violence firsthand. He grew fascinated, and outraged, by extrapolations from an illusory normal—the evil of banality. “I later saw the exact same illusion of understanding in business success and the financial markets,” he writes.

“Later” began in 1983, when, after university in Paris, and a Wharton M.B.A., Taleb became an options trader—“my core identity,” he says. Over the next twelve years, he conducted two hundred thousand trades, and examined seventy thousand risk-management reports. Along the way, he developed an investment strategy that entailed exposure to regular, small losses, while positioning him to benefit from irregular, massive gains—something like a venture capitalist. He explored, especially, scenarios for derivatives: asset bundles where fat tails—price volatilities, say—can either enrich or impoverish traders, and do so exponentially when they increase the scale of the movement.

These were the years, moreover, when, following Japan, large U.S. manufacturing companies were converting to “just-in-time” production, which involved integrating and synchronizing supply-chains, and forgoing stockpiles of necessary components in favor of acquiring them on an as-needed basis, often relying on single, authorized suppliers. The idea was that lowering inventory would reduce costs. But Taleb, extrapolating from trading risks, believed that “managing without buffers was irresponsible,” because “fat-tail events” can never be completely avoided. As the Harvard Business Review reported this month, Chinese suppliers shut down by the pandemic have stymied the production capabilities of a majority of the companies that depend on them.

The coming of global information networks deepened Taleb’s concern. He reserved a special impatience for economists who saw these networks as stabilizing—who thought that the average thought or action, derived from an ever-widening group, would produce an increasingly tolerable standard—and who believed that crowds had wisdom, and bigger crowds more wisdom. Thus networked, institutional buyers and sellers were supposed to produce more rational markets, a supposition that seemed to justify the deregulation of derivatives, in 2000, which helped accelerate the crash of 2008.

As Taleb told me, “The great danger has always been too much connectivity.” Proliferating global networks, both physical and virtual, inevitably incorporate more fat-tail risks into a more interdependent and “fragile” system: not only risks such as pathogens but also computer viruses, or the hacking of information networks, or reckless budgetary management by financial institutions or state governments, or spectacular acts of terror. Any negative event along these lines can create a rolling, widening collapse—a true black swan—in the same way that the failure of a single transformer can collapse an electricity grid.

COVID-19 has initiated ordinary citizens into the esoteric “mayhem” that Taleb’s writings portend. Who knows what will change for countries when the pandemic ends? What we do know, Taleb says, is what cannot remain the same. He is “too much a cosmopolitan” to want global networks undone, even if they could be. But he does want the institutional equivalent of “circuit breakers, fail-safe protocols, and backup systems,” many of which he summarizes in his fourth, and favorite, book, “Antifragile,” published in 2012. For countries, he envisions political and economic principles that amount to an analogue of his investment strategy: government officials and corporate executives accepting what may seem like too-small gains from their investment dollars, while protecting themselves from catastrophic loss.

Anyone who has read the Federalist Papers can see what he’s getting at. The “separation of powers” is hardly the most efficient form of government; getting something done entails a complex, time-consuming process of building consensus among distributed centers of authority. But James Madison understood that tyranny—however distant it was from the minds of likely Presidents in his own generation—is so calamitous to a republic, and so incipient in the human condition, that it must be structurally mitigated. For Taleb, an antifragile country would encourage the distribution of power among smaller, more local, experimental, and self-sufficient entities—in short, build a system that could survive random stresses, rather than break under any particular one. (His word for this beneficial distribution is “fractal.”)

We should discourage the concentration of power in big corporations, “including a severe restriction of lobbying,” Taleb told me. “When one per cent of the people have fifty per cent of the income, that is a fat tail.” Companies shouldn’t be able to make money from monopoly power, “from rent-seeking”—using that power not to build something but to extract an ever-larger part of the surplus. There should be an expansion of the powers of state and even county governments, where there is “bottom-up” control and accountability. This could incubate new businesses and foster new education methods that emphasize “action learning and apprenticeship” over purely academic certification. He thinks that “we should have a national Entrepreneurship Day.”

But Taleb doesn’t believe that the government should abandon citizens buffeted by events they can’t possibly anticipate or control. (He dedicated his book “Skin in the Game,” published in 2018, to Ron Paul and Ralph Nader.) “The state,” he told me, “should not smooth out your life, like a Lebanese mother, but should be there for intervention in negative times, like a rich Lebanese uncle.” Right now, for example, the government should, indeed, be sending out checks to unemployed and gig workers. (“You don’t bail out companies, you bail out individuals.”) He would also consider a guaranteed basic income, much as Andrew Yang, whom he admires, has advocated. Crucially, the government should be an insurer of health care, though Taleb prefers not a centrally run Medicare-for-all system but one such as Canada’s, which is controlled by the provinces. And, like responsible supply-chain managers, the federal government should create buffers against public-health disasters: “If it can spend trillions stockpiling nuclear weapons, it ought to spend tens of billions stockpiling ventilators and testing kits.”

At the same time, Taleb adamantly opposes the state taking on staggering debt. He thinks, rather, that the rich should be taxed as disproportionately as necessary, “though as locally as possible.” The key is “to build on the good days,” when the economy is growing, and reduce the debt, which he calls “intergenerational dispossession.” The government should then encourage an eclectic array of management norms: drawing up political borders, even down to the level of towns, which can, in an epidemiological emergency, be closed; having banks and corporations hold larger cash reserves, so that they can be more independent of market volatility; and making sure that manufacturing, transportation, information, and health-care systems have redundant storage and processing components. (“That’s why nature gave us two kidneys.”) Taleb is especially keen to inhibit “moral hazard,” such as that of bankers who get rich by betting, and losing, other people’s money. “In the Hammurabi Code, if a house falls in and kills you, the architect is put to death,” he told me. Correspondingly, any company or bank that gets a bailout should expect its executives to be fired, and its shareholders diluted. “If the state helps you, then taxpayers own you.”

Some of Taleb’s principles seem little more than thought experiments, or fit uneasily with others. How does one tax more locally, or close a town border? If taxpayers own corporate equities, does this mean that companies might be nationalized, broken up, or severely regulated? But asking Taleb to describe antifragility to its end is a little like asking Thomas Hobbes to nail down sovereignty. The more important challenge is to grasp the peril for which political solutions must be designed or improvised; society cannot endure with complacent conceptions of how things work. “It would seem most efficient to drive home at two hundred miles an hour,” he put it to me.“But odds are you’d never get there.”

A Guide to the Coronavirus

Bernard Avishai teaches political economy at Dartmouth and is the author of “The Tragedy of Zionism,” “The Hebrew Republic,” and “Promiscuous,” among other books. He was selected as a Guggenheim fellow in 1987.

The anti-quarantine protests seem spontaneous. But behind the scenes, a powerful network is helping (Washington Post)

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washingtonpost.com

Isaac Stanley-Becker and Tony Romm, April 22, 2020

A network of right-leaning individuals and groups, aided by nimble online outfits, has helped incubate the fervor erupting in state capitals across the country. The activism is often organic and the frustration deeply felt, but it is also being amplified, and in some cases coordinated, by longtime conservative activists, whose robust operations were initially set up with help from Republican megadonors.

The Convention of States project launched in 2015 with a high-dollar donation from the family foundation of Robert Mercer, a billionaire hedge fund manager and Republican patron. It boasts past support from two members of the Trump administration — Ken Cuccinelli, acting director of U.S. Citizenship and Immigration Services, and Ben Carson, secretary of housing and urban development.

It also trumpets a prior endorsement from Ron DeSantis, the Republican governor of Florida and a close Trump ally who is pursuing an aggressive plan to reopen his state’s economy. A spokesman for Carson declined to comment. Cuccinelli and DeSantis did not respond to requests for comment.

The initiative, aimed at curtailing federal power, is now leveraging its sweeping national network and digital arsenal to help stitch together scattered demonstrations across the country, making opposition to stay-at-home orders appear more widespread than is suggested by polling.

“We’re providing a digital platform for people to plan and communicate about what they’re doing,” said Eric O’Keefe, board president of Citizens for Self-Governance, the parent organization of the Convention of States project.

A longtime associate of the conservative activist Koch family, O’Keefe helped manage David Koch’s 1980 bid for the White House when he served as the No. 2 on the Libertarian ticket.

“To shut down our rural counties because of what’s going on in New York City, or in some sense Milwaukee, is draconian,” said O’Keefe, who lives in Wisconsin.

Polls suggest most Americans support local directives encouraging them to stay at home as covid-19, the disease caused by the new coronavirus, ravages the country, killing more than 44,000 people in the United States so far. Public health officials, including epidemiologists advising Trump’s White House, agree that sweeping restrictions represent the most effective mitigation strategy in the absence of a vaccine, which could be more than a year away.

Still, some activists insist that states should lift controls on commercial activity and public assembly, citing the effects of mass closures on businesses. They have been encouraged at times by Trump, whose attorney general, William P. Barr, said in an interview with radio host Hugh Hewitt on Tuesday that the Justice Department would consider supporting lawsuits against restrictions that go “too far.”

The swelling frustration on the right coincides with major policy changes in some states, especially those with Republican governors. Georgia, South Carolina and Tennessee have all begun relaxing their restrictions in recent days after bowing to pressure and imposing far-reaching guidelines.

The protests are reminiscent in some ways of the tea party movement and the demonstrations against the Affordable Care Act that erupted in 2010, which also involved a mix of homegrown activism and shrewd behind-the-scenes funding.

For the Convention of States, public health is an unusual focus. It was founded to push for a convention that would add a balanced-budget amendment to the Constitution. That same anti-government impulse is now animating the group’s campaign against coronavirus precautions.

“Heavy-handed government orders that interfere with our most basic liberties will do more harm than good,” read its Facebook ads, which had been viewed as many as 36,000 times as of Tuesday evening.

Asking for a $5 donation “to support our fight,” the paid posts are part of an online blitz called “Open the States,” which also includes newly created websites, a data-collecting petition and an ominous video about the economic effects of the lockdown.

The group’s president, Mark Meckler, said his aim was to act as a “clearinghouse where these guys can all find each other” — a role he learned as co-founder of the Tea Party Patriots. FreedomWorks, a libertarian advocacy group also active in the tea party movement, is seeking to play a similar function, creating an online calendar of protests.

“The major need back in 2009 was no different than it is today — some easy centralizing point to list events, to allow people to communicate with each other,” he said.

Meckler, who draws a salary of about $250,000 from the Convention of States parent group, a tax-exempt nonprofit organization, according to filings with the Internal Revenue Service, hailed the “spontaneous citizen groups self-organizing on the Internet and protesting what they perceive to be government overreach.”

So far, the protests against stay-at-home orders in states including Washington and Pennsylvania have captured headlines and drawn rebukes from some governors and epidemiologists. Experts say a sudden, widespread reopening of the country is likely to worsen the outbreak, overwhelming hospitals and killing tens of thousands.

The protesters so far have not aimed their ire at Trump, though it is his administration’s experts whose guidelines underlie many of the states’ actions.

Trump’s public comments — including his recent tweets calling for supporters to “liberate” states including Michigan, a coronavirus hot spot — have catalyzed some of the broader public reaction. Following those tweets, tens of thousands of people joined Facebook groups calling for protests in states including Pennsylvania and Ohio, where the efforts are coordinated by a trio of brothers who typically focus their efforts on fighting gun control.

In recent days, conservatives have set their sights on Wisconsin, where a few dozen protesters turned out at the Capitol to air their frustrations with Gov. Tony Evers, a Democrat, after he extended his state’s stay-at-home order until late May. Ahead of the demonstration, Moore, the Trump ally, revealed on a live stream that he was “working with a group” in the state with the goal of trying “to shut down the capital.”

Moore, who served as a Trump campaign adviser in 2016, said he had located a big donor to aid in the effort, though he never elaborated. “I told him about this, and he said, ‘Steve, I promise to pay the bail and legal fees for anyone who gets arrested,’ ” Moore said in the video. He likened his quest to the civil rights movement, adding, “We need to be the Rosa Parks here and protest against these government injustices.”

Moore, who has also worked at the right-leaning Heritage Foundation, did not respond to a request for comment.

In Michigan, among those organizing “Operation Gridlock” was Meshawn Maddock, who sits on the Trump campaign’s advisory board and is a prominent figure in the “Women for Trump” coalition. Funds to promote the demonstrations on Facebook came from the Michigan Freedom Fund, which is headed by Greg McNeilly, a longtime adviser to the family of Education Secretary Betsy DeVos.

McNeilly said the money used to advance the anti-quarantine protests came from “grass-roots fundraising efforts” and had “nothing to do with any DeVos work.”

Many of the seemingly scattered, spontaneous outbursts of citizen activism reflect deeply interwoven networks of conservative and libertarian nonprofit organizations. One of the most vocal groups opposing the lockdown in Texas is an Austin-based conservative think tank called the Texas Public Policy Foundation, which also hails the demonstrations nationwide.

“Some Americans are angry,” its director wrote in an op-ed promoted on Facebook and placed in the local media, telling readers in Texas about the achievements of protesters in Michigan.

The board vice chairman of the Texas Public Policy Foundation, oil executive Tim Dunn, is also a founding board member of the group promoting the Convention of States initiative. And the foundation’s former president, Brooke Rollins, now works as an assistant to Trump in the Office of American Innovation.

Neither Dunn nor Rollins responded to requests for comment.

The John Hancock Committee for the States — the name used in IRS filings by the group behind the Convention of States — gave more than $100,000 to the Texas Public Policy Foundation in 2011.

The Convention of States project, meanwhile, has received backing from DonorsTrust, a tax-exempt financial conduit for right-wing causes that does not disclose its contributors. The same fund has helped bankroll the Idaho Freedom Foundation, which is encouraging protests of a stay-at-home order imposed by the state’s Republican governor, Brad Little.

“Disobey Idaho,” say its Facebook ads, which use an image of the “Join or Die” snake woodcut emblematic of the Revolutionary War and later adopted by the tea party movement.

In 2014, the year before it launched the Convention of States initiative, Citizens for Self-Governance received $500,000 from the Mercer Family Foundation, a donation Meckler said helped jump-start the campaign. Mercer declined to comment.

While groups and individual activists associated with the Koch brothers have boosted this far-flung network, Emily Seidel, the chief executive of the Koch-backed Americans for Prosperity advocacy group, sought to distance the organization from the protest activity, which she said was “not the best way” to “get people back to work.”

“Instead, we are working directly with policymakers, to bring business leaders and public health officials together to help develop standards to safely reopen the economy without jeopardizing public health,” Seidel said.

But others see linkages to groups pushing anti-quarantine uprisings.

“The involvement of the Koch institutional apparatus in groups supporting these protests is clear to me,” said Robert J. Brulle, a sociologist at Drexel University whose research has focused on climate lobbying. “The presence of allies on the board usually means that they are deeply engaged in the organization and most likely a funder.”

Brulle said the blowback against the coronavirus precautions carries echoes of efforts to deny climate change, both of which rely on hostility toward government action.

“These are extreme right-wing efforts to delegitimize government,” he said. “It’s an anti-government crusade.”

Philippe Descola: “Diante do monstruoso choque epidêmico das grandes conquistas, os povos ameríndios usaram a dispersão para sobreviver” (France Culture)

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20 de abril de 2020 – traduzido por Google Translator; revisado por Renzo Taddei

Você pode ouvir a entrevista completa, em francês, no artigo original.

Enquanto o mundo está parado, observamos a primavera florescer da nossa janela. E se, paradoxalmente, ser separado da natureza nos aproximar dela? Como repensar a coabitação entre homens e não-humanos?

Philippe Descola, anthropologue, professeur émérite au Collège de France et chaire Anthropologie de la nature est l'invité exceptionnel des Matins ce lundi
Philippe Descola, antropólogo, professor emérito do Collège de France e titular da cadeira de antropologia da natureza, é o convidado especial nesta segunda-feira • Créditos: FREDERICK FLORIN – AFP

Embora o vínculo do homem com o meio ambiente esteja diretamente envolvido nessa crise de saúde, devemos repensar nosso relacionamento com a natureza? É o que propõe Philippe Descola, a quem estamos recebendo hoje. Em 1976, ele partiu como estudante para descobrir os Achuars, um povo Jivaro localizado no coração da Amazônia, entre o Equador e o Peru. A experiência gerou uma longa reflexão sobre o antropocentrismo que abre o caminho para uma nova relação entre os seres humanos e seu ambiente.

A epidemia é uma consequência da ação humana sobre a natureza? É uma doença do Antropoceno? O que podemos aprender com o vínculo que certas pessoas têm com o meio ambiente?

Philippe Descola é professor emérito do Collège France, titular da cadeira de antropologia da natureza de 2000 a 2019. Ele é o autor de Les natures en question (Ed. Odile Jacob, 2017).

Qual a resposta dos achuars às epidemias?

“Não há lembranças do desastre. Estima-se que cerca de 90% da população ameríndia desapareceu entre os séculos XVI e XIX. Existe uma espécie de imaginação implícita do contato com a doença dos “brancos”. Portanto, quando os “brancos” chegaram nos remotos ambientes ameríndios, o primeiro reflexo dos ameríndios foi a desconfiança e o distanciamento.”

A doença é apenas um elemento em uma procissão de abominações provocada pela colonização. Philippe Descola

“Cada povo reagiu às suas epidemias de acordo com sua concepção de contágio. A noção de contágio levou algum tempo para se espalhar na Europa, diferentemente dos povos ameríndios. Foi isso que lhes permitiu adotar as ações corretas.”

Falando em “natureza”: um erro?

“A natureza é um conceito ocidental que designa todos os não-humanos. E essa separação entre humanos e não-humanos resultou na introdução de uma distância social entre eles”.

Você pode pensar que o vírus é uma metáfora para a humanidade. Temos o mesmo relacionamento instrumental com a Terra que um vírus. De certa forma, os seres humanos são o patógeno do planeta. Philippe Descola

“Essa ideia muito humana de que a natureza é infinita resultou nesse sistema singular, baseado em produtividade e lucratividade, que causou uma catástrofe planetária”.

O ideal do “mundo depois”

“Espero que o próximo mundo seja diferente do anterior. A pandemia nos dá um marcador temporário. Essa transformação, eu vejo isso com interesse, está tomando forma e vínculos com seres não-humanos são tecidos novamente. Temos que viver com uma mentalidade que não destrua o meio ambiente “.

A idéia não é possuir a natureza, mas ser possuído por um ambiente. Philippe Descola

The Impossible Ethics of Pandemic Triage (The Atlantic)

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Original article

Aaron Kheriaty – April 3, 2020

Is there a formula for deciding which patients doctors try to save?

If help does not arrive quickly, several hospitals in New York will soon run out of ventilators. Doctors at these hospitals will then face anguishing choices — if the word “choice” is even applicable when every available option is an awful one.

Imagine that Mr. Jones was intubated yesterday in an NYC hospital. He is not imminently dying, though his chances of surviving Covid-19 are uncertain. Mrs. Smith, another Covid-19 case, now requires intubation in the same hospital’s emergency room. She is twenty years younger than Jones, and without his diabetes and hypertension, so her prognosis for recovery is better. But yesterday Jones took the last ventilator in the ICU. If we leave Mr. Jones on the vent, Mrs. Smith will die. If we take Jones off the vent to give it to Smith, then he will die.

If we choose the younger, healthier Mrs. Smith over the older, sicker Mr. Jones, this might appear to be age discrimination. On the other hand, the coronavirus itself engages in age discrimination, killing those over 70 at a much higher rate — so age itself appears to be a medically relevant prognostic factor in many cases.

Most physicians are not trained as wartime medics. We have never before faced these battlefield triage decisions. And with the coronavirus pandemic, there are additional ethical complications. That NYC hospital is also running out of N95 masks and proper gowns to protect staff from infection. Health care workers certainly have a duty to care for the sick. Just as firefighters run into burning buildings while others run away, so also we treat contagious patients while others are socially distancing.

But just as firefighters never signed up to run into burning buildings in their boxer shorts, so also doctors and nurses did not sign up to treat infectious diseases without basic personal protective equipment — gowns, gloves, and masks that cost pennies apiece yet somehow are in short supply. When this PPE is gone, and doctors lack even the most basic barriers against infection, should the 70-year-old physician have to stay in the game? What about the 28-year-old pregnant medical resident who has an elderly immunocompromised grandfather living at home?

Suppose during this crisis we stretch the duty to treat contagious patients to heroic proportions. This is part of the physician’s job, so it is all hands on deck. After a few weeks of this strategy, and before more N95 masks arrive, half of the emergency and ICU physicians in this NYC hospital are home sick with the cursed virus, and one of the hospital’s docs is sick enough to need — guess what? — a ventilator. So this doctor returns to her hospital as a patient.

Should we then pull Mrs. Jones off the ventilator and offer it to the infected physician, who after all acquired Covid-19 while on the front lines heroically risking her own health to care for patients? If we are not convinced by the argument from reciprocity (that she deserves some reward for these efforts), what about the “multiplier effect”? If our central ethical principle under crisis conditions is to save as many lives as possible, it seems plausible that saving this ICU physician — if she recovers and returns to the fray — could help save the lives of more patients. Doctors are in short supply and cannot be easily replaced.

Okay, fine — perhaps we can prioritize doctors, all other things being equal in terms of prognosis. But many other workers are also critical to the pandemic response. Perhaps we can “replace” food service workers and janitors — as distasteful as it is to put it in those terms and think of our fellow human beings in that way — but what about the lead scientist on a project to develop a coronavirus vaccine? Or the police chief of New York? Or any police officer or firefighter, for that matter? What about a priority nudge for pregnant patients on the basis of this same multiplier effect? How should we draw the line around this category of “critical workers” or others who can get a bump up the triage list?

Draw the line too broadly, encompassing anyone still working during the crisis, and such priority quickly becomes meaningless. Draw it too narrowly and you exclude others who are also essential. In any case, if we consider some to be indispensable in this hour, does this not imply that others — the artists and poets, the homeless and unemployed — are dispensable? How will such practices shape our attitudes and impact social solidarity once the virus is gone and the dust has settled?

Suppose we attempt to resolve these puzzles by sticking only to objective clinical criteria: no special priority for anyone, no triage categories that are not directly related to prognosis. We do our best to predict which patients will have the best short-term survival outcomes, give them first priority on scarce resources like ventilators, and save as many people as possible. This seems sensible enough, until we realize that those Covid-19 patients with the best prognosis are typically the ones without medical conditions like diabetes, hypertension, and cardiac disease. But these people are often healthier because they eat healthy food (which is more expensive than McDonald’s), work out at fancy gyms (also expensive), and have access to good medical care (very expensive).

So a triage system that appears at first glance to be fair and medically objective turns out to have the potential for exacerbating social inequalities. The populations that were most vulnerable before a disaster are likely to be among the most vulnerable during a disaster. On the other hand, our mandate is to save as many lives as possible, not to right all wrongs. If devising a medically fair pandemic triage system is frightfully hard, devising a socially fair system seems impossible.

Triage scenarios are not hypothetical fantasies: they are happening in Italy and they are on the verge of happening here. Even as we hope and pray for the best, we have to plan for the worst — and prepare for it quickly.

For the past several weeks, these and a thousand other bewildering questions have been keeping my colleagues and me awake at night. After working on these issues round the clock with colleagues at my hospital who specialize in ethics, critical care, anesthesiology, emergency medicine, and nursing, I recently joined a task force to devise a pandemic triage protocol for all hospitals in the University of California system. These are some of the most remarkable people I know, and most have skin in the game as physicians on the front lines.

UC hospitals are well prepared for a large coronavirus surge, but many of California’s smaller private and community hospitals may not be so fortunate. These times call for the sharing of resources between hospitals, for transfers of care, for institutional solidarity. Our hospitals’ resources belong not to us, but to the citizens of California, and even to those beyond our state borders.

We are not starting from scratch or reinventing the wheel in our deliberations. Many thoughtful ethicists and dedicated clinicians have examined these questions in the bioethics research literature. And several states have published guidelines on these thorny questions, often with input from citizens. Yet most of this background work was done when these questions were hypothetical, while the guidelines we are producing now may soon be deployed on the ground.

In the few moments when we slow down, we occasionally think about the opportunistic lawyers and prosecutors who will later go after doctors no matter what choices we make. This is not to mention the Monday morning quarterbacks who will second-guess these choices with the benefit of hindsight, limitless time, and much more retrospective data. Well, fine — let armies of graduate students earn their Ph.D.’s in the coming years by telling us what we could have done better.

Honestly, most of the time we just worry about our patients. We picture the droves of sick people, barely able to breathe, who will arrive any day now at our hospital doors in ever expanding numbers. We wonder how we will explain our decision to an anguished daughter when we have to look her in the eye and say, “We are sorry, your father will not be placed on a ventilator but will be transitioned to comfort care only.” How will we explain this when a month ago he would have received treatment without question, and might have recovered?

None of this makes sense and none of us thought we would ever be in this position. Yet here we are.

We have deliberated about duty, justice, equality, fairness, transparency. These principles can never be abandoned even in a crisis. Yet something lingers always in the background of our efforts. There is an inescapably tragic undercurrent to all of this, however upright our intentions. This one unsettling fact always remains to haunt us: If hospitals exceed their surge capacity, patients who otherwise would have lived will die. Lives will be lost simply because we lacked the resources to offer everyone the basics of modern medicine.

T. S. Eliot saw the limits of our ability to rectify all wrongs and balance the scales of justice when he wrote, “For us, there is only the trying. The rest is not our business.” My colleagues and I, like so many others in these strange times, are trying our best. But controlling and managing this pandemic is beyond our abilities, indeed, beyond anyone’s abilities. In the absence of a God’s-eye view, in the absence of unlimited resources, in the absence of a crystal ball that can perfectly prognosticate outcomes, physicians are left to humbly do whatever we can — even as we know that this will not be enough. For us there is only the trying. The rest is marked by tragedy.

Aaron Kheriaty, M.D., is an associate professor of psychiatry and human behavior, and director of the Medical Ethics Program, at the University of California Irvine School of Medicine.

Aaron Kheriaty, “The Impossible Ethics of Pandemic Triage,” TheNewAtlantis.com, April 3, 2020.

Para estudioso do clima, “sorte” explica pandemia não começar pelo Brasil (ECOA/UOL)

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Artigo original

Rodrigo Bertolotto De Ecoa, em São Paulo 14/04/2020 18h04

“A Amazônia tem a maior quantidade de microorganismos do mundo. E estamos perturbando o sistema o tempo todo, com populações urbanas se aproximando, desmatamento e comércio de animais silvestres. Então, talvez tenha sido sorte que a pandemia não tenha começado no Brasil”, disse Carlos Nobre, presidente do Painel Brasileiro de Mudanças Climáticas e pesquisador sênior do Instituto de Estudos Avançados da USP (Universidade de São Paulo).

O cientista Carlos Nobre, referência brasileira em estudos sobre aquecimento global e pesquisador do Instituto Nacional de Pesquisa Espacial (Inpe) - Reinaldo Canato/Folhapress
O cientista Carlos Nobre, referência brasileira em estudos sobre aquecimento global e pesquisador do Instituto Nacional de Pesquisa Espacial (Inpe) Imagem: Reinaldo Canato/Folhapress

Nobre participou nesta terça de um seminário “Covid-19 e Clima: Como Estão Conectados?” promovido pela Rede Brasil do Pacto Global da ONU (Organização das Nações Unidas) em parceria com Ecoa, que retransmitiu sua palestra, no formato webinar, ou seja, um seminário pela web.

“Pandemia mostra impacto do desequilíbrio do sistema na nossa vida”

Ele lembrou do caso da leishmaniose, endemia típica da Amazônia que tem como causador um protozoário e o vetor é o mosquito palha. A doença se espalhou pelo mundo, devido à aproximação dos homens dos ambientes silvestres, mas agora está controlada, tendo cura e remédio. O problema agora é outro por lá. “Agora, Manaus está entrando em colapso com o coronavírus, e a doença está chegando às aldeias. Temos que lembrar que os indígenas têm menos resistência imunológica a essas contaminações.”

Nobre também falou como a poluição debilita quem tem contado agora com o vírus surgido na China no final de 2019. “A poluição e o vírus atacam o sistema respiratório. Essa combinação é muito perversa”, afirmou o estudioso.

Ele recordou das queimadas na floresta amazônica em 2019, a que ponto isso afetou os ares até da região Sudeste do Brasil e como esse cenário pode se repetir agora em 2020, quando se está verificando novos recordes de desmatamento.

O ar de São Paulo e outras cidades está mais limpo com menos carros em circulação nesses dias de quarentena, mas, se as queimadas recomeçarem, esse cenário vai mudar e criar novas vulnerabilidades. No ano passado, os postos de saúde da Amazônia estavam cheios pela fumaça das queimadas. Agora estão com a Covid-19.

Aprendizados da crise

O cientista discutiu os vários pontos que aproximam o atual surto biológico com os problemas climáticos, sua especialidade.

“Dá para fazer um paralelo entre essas crises globais. Essa pandemia nos mostra o que pode acontecer quando há um desequilíbrio do sistema. Ela é um alerta e um guia para evitarmos grandes riscos, como os que as mudanças climáticas poderão trazer para a vida na Terra. Se a temperatura do planeta subir cinco graus, os humanos vão ter de viver confinados, como agora, porque em determinados horários todos os dias o termômetro vai estar além do limite fisiológico do corpo nas áreas tropicais como o Brasil.”

Nobre falou das lições que podem ficar desta crise global e das possíveis soluções quando o planeta sair das urgências do coronavírus. Para ele, um dos aprendizados é que a economia caminhe para a sustentabilidade.

“Os países europeus estão discutindo agora uma economia mais verde. E a China também está sinalizando nesse mesmo caminho. Se isso acontecer, o pêndulo mundial vai mudar, e o Brasil vai ter de ir atrás. Os EUA são contra, mas isso pode mudar se em janeiro de 2021 não estiver mais o Donald Trump na Casa Branca”, afirmou Nobre, projetando as dificuldades de reeleição do político republicano com a possível recessão provocada pelo afastamento social durante a crise.

O pesquisador também salientou que é importante mudar a matriz energética, e essa crise pode ser o momento de acelerar esse processo. “Precisamos eletrificar os transportes, e criar mais energia solar e eólica, diminuindo o consumo de combustíveis fósseis.”

Para ele, as mudanças climáticas vão trazer riscos maiores que os atuais com o coronavírus se não forem tomadas providências. “É uma catástrofe com um tempo e uma magnitude muito maior. Por isso, é difícil dimensionar. Mas a atual pandemia é uma amostra disso. E um risco maior também, afinal, todo o planeta vai ser afetado, não só o homem, como agora.”

Veja íntegra do seminário: https://video.uol/18QVJ

Esse desconforto que você está sentindo é luto (HBR/Medium)

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Por Scott Berinato, da Harvard Business Review. Traduzido por Ana Marcela Sarria (aqui); revisado por Renzo Taddei.

Texto original em inglês

HBR Staff/d3sign/Getty Images

Parte da equipe da HBR se reuniu virtualmente outro dia — uma tela cheia de rostos, numa cena que está se tornando cada vez mais comum por todos lados. Falamos sobre o conteúdo que estamos produzindo nestes tempos angustiantes e como podemos ajudar as pessoas. Mas também falamos sobre como estamos nos sentindo. Uma colega mencionou que o que ela sentia era luto. Cabeças acenaram em concordância na tela.

Se podemos nomeá-lo, talvez possamos lidar com ele. Conversamos com David Kessler sobre ideias de como fazer isso. Kessler é um grande especialista em luto. Ele co-escreveu, com Elisabeth Kübler-Ross, o livro On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. Seu novo livro adiciona outro estágio no processo, Finding Meaning: The Sixth Stage of Grief. Kessler também trabalhou por uma década no sistema hospitalar de Los Angeles. Ele participou da equipe de risco biológico. Seu trabalho voluntário inclui ser membro da Reserva de Especialistas da polícia de Los Angeles para eventos traumáticos, assim como ter servido na equipe de serviços em situação de desastre da Cruz Vermelha. Ele é o fundador do www.grief.com, que tem mais de 5 milhões de visitas anuais advindas de 167 países.

Kessler compartilhou seus pensamentos sobre por que é importante reconhecer o luto que você pode estar sentindo, como controlá-lo, e por que ele acredita que vamos encontrar um sentido nele. A conversa está levemente editada para garantir maior clareza.

HBR: As pessoas estão sentindo muitas coisas agora. Écorreto chamar algumas das coisas que elas estão sentindo de luto?

Kessler: Sim, e estamos sentindo vários lutos diferentes. Estamos sentindo que o mundo mudou, e ele mudou mesmo. Sabemos que é temporário, mas não sentimos que seja, e compreendemos que as coisas vão ser diferentes. Assim como ir ao aeroporto mudou para sempre depois do 11 de setembro, as coisas vão mudar e este é o ponto no qual mudaram. A perda da normalidade; o medo do estrago econômico; a perda de conexão. Estamos sendo afetados por essas coisas, e estamos em luto. Não estamos acostumados a este tipo de luto coletivo no ar.

Você disse que estamos sentindo mais de um tipo de luto?

Sim, estamos sentindo, também, luto antecipado. Luto antecipado é esse sentimento que temos sobre o que o futuro nos reserva quando estamos incertos a respeito. Normalmente se centra na morte. Sentimos isso quando alguém tem um diagnóstico ruim, ou quando pensamos a respeito do fato de que vamos perder nosso pais em algum momento. Luto antecipado é também, mais maneira mais geral, sobre futuros imaginados. Tem uma tempestade chegando. Tem algo ruim lá fora. Com um vírus, este tipo de luto é muito confuso para as pessoas. Nossa cognição sabe que algo ruim está acontecendo, mas não podemos vê-lo. Isso rompe nosso sentido de segurança. Estamos sentindo a perda da segurança. Eu acho que jamais havíamos perdido coletivamente nosso senso geral de segurança desta forma. Indivíduos ou grupos específicos passaram por isso, mas isso é inédito em escala planetária. Estamos em luto nos níveis micro e macro.

O quê podemos fazer para lidar com o luto?

Entender os estágios do luto é um começo. Mas sempre que falo sobre os estágios do luto, eu lembro as pessoas de que os estágios não são lineares e podem não acontecer nessa ordem. Não é um mapa, mas nos fornece uma plataforma para acessar este mundo desconhecido. Existe a negação, que acontece bastante no início: “este vírus não vai nos afetar”. Existe a raiva: “vocês estão nos fazendo ficar em casa e tirando nossos trabalhos”. Existe a barganha: “ok, se estabelecemos o distanciamento social por duas semanas, tudo vai melhorar, certo?”. Existe a tristeza: “eu não sei quando isto vai terminar”. E, finalmente, a aceitação: “isto está acontecendo; eu tenho que descobrir como seguir adiante”.

A aceitação, como você pode imaginar, é onde está nosso poder. Encontramos o controle quando chegamos na fase da aceitação. “Eu posso lavar minhas mãos. Eu posso manter uma distância segura. Eu posso aprender a trabalhar virtualmente.”

Quando estamos sentindo luto, existe uma dor física. E a mente acelerada. Existem técnicas para lidar com isso e fazer com que seja menos intenso?

Vamos voltar para o luto antecipado. Luto antecipado não-saudável é, na verdade, ansiedade; esse é o sentimento sobre o qual você está falando. Nossa mente começa a nos mostrar imagens. Meus pais ficando doentes. Vemos os piores cenários. Essa é nossa mente sendo protetiva. Nosso objetivo é não ignorar essas imagens ou tentar fazê-las ir embora — sua mente não vai deixar você fazer isso e pode ser doloroso se você forçar. O objetivo é encontrar o equilíbrio nas coisas que você está pensando. Se você sente que imagens ruins estão tomando forma, mude o seu pensamento para imagens positivas. Todos nós ficamos doentes e o mundo segue adiante. Nem todo mundo que eu amo morre. Talvez não morram porque estamos todos fazendo as coisas certas. Nenhum cenário deve ser ignorado, mas nenhum deve dominar também.

Luto antecipado é a mente projetando-se para o futuro e imaginando o pior. Para se acalmar, você quer voltar para o presente. Este conselho vai soar familiar para qualquer pessoa que já meditou ou praticou mindfulness, mas as pessoas podem sempre se surpreender com o quão simples isto pode ser. Você pode nomear cinco coisas que estão na sala onde você está. Existe um computador, uma cadeira, uma foto de um cachorro, um tapete velho e uma xícara de café. É simples assim. Respire. Perceba que, no momento presente, nada do que você tinha antecipado aconteceu. Neste momento, você está bem. Você tem comida. Você não está doente. Use seus sentidos e pense sobre o que eles sentem. A mesa é dura. O cobertor é macio. Eu consigo sentir o ar entrando em minhas narinas. Isto efetivamente funciona para reduzir a dor.

Você também pode pensar sobre como abrir mão do que você não tem controle. O que seu vizinho está fazendo está fora do seu controle. O que está no seu controle é ficar a um metro de distância dele, e lavar suas mãos. Foque nisso.

Finalmente, é um bom momento para multiplicar a compaixão. As pessoas vão ter níveis diferentes de medo e luto e isso se manifesta de formas diferentes. Uma pessoa com quem trabalho ficou muito rude comigo outro dia e eu pensei: “não parece a mesma pessoa; essa é a forma como a pessoa está lidando com a situação. Estou vendo seu medo e ansiedade”. Então seja paciente. Pense sobre como as pessoas geralmente são e não quem elas parecem ser neste momento.

Um aspecto particularmente perturbador nesta pandemia é não saber quando ela acaba.

Isto é um estado temporário. Ajuda falar sobre isso. Eu trabalhei 10 anos no sistema hospitalar. Eu fui treinado para situações como esta. Eu também estudei a pandemia da gripe de 1918. As precauções que estamos tomando são corretas. A história nos conta isso. Isto se chama sobrevivência. Vamos sobreviver. Este é um tempo de se superproteger, mas não se reagir de forma desmedida.

E acredito que vamos encontrar sentido nisto. Eu fiquei honrado que a família de Elisabeth Kübler-Ross me deu permissão para acrescentar um sexto estado ao luto: significado. Eu tinha falado bastante com Elisabeth sobre o que viria depois da aceitação. Eu não quis parar na aceitação quando experimentei o luto pessoal. Eu quis significado naquelas horas mais difíceis. E efetivamente acredito que encontramos iluminação nestes momentos. Agora mesmo as pessoas estão percebendo que elas podem se conectar através da tecnologia. Elas não estão tão distantes quanto imaginavam. Elas estão percebendo que podem usar seus telefones para conversas longas. Estão apreciando caminhadas. Eu acredito que vamos continuar encontrando significado agora e quando isso tiver acabado.

O que você diria para alguém que lê tudo isto e ainda assim se sente sobrecarregado com o luto?

Continue tentando. Há algo poderoso em nomear o luto. Isso nos ajuda a sentir o que está dentro de nós. Tantas pessoas me disseram na última semana: “estou dizendo para meus colegas de trabalho que estou tendo dificuldades” ou “chorei na noite passada”. Quando você nomeia o luto, você é mais capaz de senti-lo e ele se move através de você. Emoções precisam de movimento. É importante que entendamos o que estamos passando. Um produto infeliz do movimento de autoajuda é que somos a primeira geração que tem emoções sobre suas emoções. Falamos para nós mesmos: “estou me sentindo triste, mas não deveria sentir isso; outras pessoas se sentem pior”. Nós podemos — devemos — parar no primeiro sentimento. “Eu me sinto triste. Vou me deixar sentir triste, por cinco minutos”. Seu objetivo nesse momento é sentir sua tristeza e medo e raiva, independente do que estejam sentindo as demais pessoas. Lutar contra isso não ajuda porque seu corpo está produzindo o sentimento. Se permitimos que os sentimentos aconteçam, eles vão acontecer de uma maneira ordenada, e nos empoderar. Então não seremos vítimas.

Numa maneira ordenada?

Sim. às vezes tentamos não sentir o que estamos sentindo porque temos essa imagem de um “bando de emoções”. Se eu me sentir triste e acolher a tristeza, ela não irá embora. O bando de emoções ruins vai me dominar. A verdade é que uma emoção se move através de nós. Não existe um bando de emoções que vai nos pegar. É absurdo pensar que não deveríamos sentir luto agora. Permita-se sentir o luto e siga adiante.

That Discomfort You’re Feeling Is Grief (HBR)

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Scott Berinato

March 23, 2020

HBR Staff/d3sign/Getty Images

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Some of the HBR edit staff met virtually the other day — a screen full of faces in a scene becoming more common everywhere. We talked about the content we’re commissioning in this harrowing time of a pandemic and how we can help people. But we also talked about how we were feeling. One colleague mentioned that what she felt was grief. Heads nodded in all the panes.

If we can name it, perhaps we can manage it. We turned to David Kessler for ideas on how to do that. Kessler is the world’s foremost expert on grief. He co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazards team. His volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross’s disaster services team. He is the founder of www.grief.com, which has over 5 million visits yearly from 167 countries.

Kessler shared his thoughts on why it’s important to acknowledge the grief you may be feeling, how to manage it, and how he believes we will find meaning in it. The conversation is lightly edited for clarity.

HBR: People are feeling any number of things right now. Is it right to call some of what they’re feeling grief?

Kessler: Yes, and we’re feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air.

You said we’re feeling more than one kind of grief?

Yes, we’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.

What can individuals do to manage all this grief?

Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren’t linear and may not happen in this order. It’s not a map but it provides some scaffolding for this unknown world. There’s denial, which we say a lot of early on: This virus won’t affect us. There’s anger: You’re making me stay home and taking away my activities. There’s bargaining: Okay, if I social distance for two weeks everything will be better, right? There’s sadness: I don’t know when this will end. And finally there’s acceptance. This is happening; I have to figure out how to proceed.

Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can wash my hands. I can keep a safe distance. I can learn how to work virtually.

When we’re feeling grief there’s that physical pain. And the racing mind. Are there techniques to deal with that to make it less intense?

Let’s go back to anticipatory grief. Unhealthy anticipatory grief is really anxiety, and that’s the feeling you’re talking about. Our mind begins to show us images. My parents getting sick. We see the worst scenarios. That’s our minds being protective. Our goal is not to ignore those images or to try to make them go away — your mind won’t let you do that and it can be painful to try and force it. The goal is to find balance in the things you’re thinking. If you feel the worst image taking shape, make yourself think of the best image. We all get a little sick and the world continues. Not everyone I love dies. Maybe no one does because we’re all taking the right steps. Neither scenario should be ignored but neither should dominate either.

Anticipatory grief is the mind going to the future and imagining the worst. To calm yourself, you want to come into the present. This will be familiar advice to anyone who has meditated or practiced mindfulness but people are always surprised at how prosaic this can be. You can name five things in the room. There’s a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It’s that simple. Breathe. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay. You have food. You are not sick. Use your senses and think about what they feel. The desk is hard. The blanket is soft. I can feel the breath coming into my nose. This really will work to dampen some of that pain.

You can also think about how to let go of what you can’t control. What your neighbor is doing is out of your control. What is in your control is staying six feet away from them and washing your hands. Focus on that.

Finally, it’s a good time to stock up on compassion. Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That’s not like this person; that’s how they’re dealing with this. I’m seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.

One particularly troubling aspect of this pandemic is the open-endedness of it.

This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I’ve been trained for situations like this. I’ve also studied the 1918 flu pandemic. The precautions we’re taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.

And, I believe we will find meaning in it. I’ve been honored that Elisabeth Kübler-Ross’s family has given me permission to add a sixth stage to grief: Meaning. I had talked to Elisabeth quite a bit about what came after acceptance. I did not want to stop at acceptance when I experienced some personal grief. I wanted meaning in those darkest hours. And I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They’re appreciating walks. I believe we will continue to find meaning now and when this is over.

What do you say to someone who’s read all this and is still feeling overwhelmed with grief?

Keep trying. There is something powerful about naming this as grief. It helps us feel what’s inside of us. So many have told me in the past week, “I’m telling my coworkers I’m having a hard time,” or “I cried last night.” When you name it, you feel it and it moves through you. Emotions need motion. It’s important we acknowledge what we go through. One unfortunate byproduct of the self-help movement is we’re the first generation to have feelings about our feelings. We tell ourselves things like, I feel sad, but I shouldn’t feel that; other people have it worse. We can — we should — stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn’t help because your body is producing the feeling. If we allow the feelings to happen, they’ll happen in an orderly way, and it empowers us. Then we’re not victims.

In an orderly way?

Yes. Sometimes we try not to feel what we’re feeling because we have this image of a “gang of feelings.” If I feel sad and let that in, it’ll never go away. The gang of bad feelings will overrun me. The truth is a feeling that moves through us. We feel it and it goes and then we go to the next feeling. There’s no gang out to get us. It’s absurd to think we shouldn’t feel grief right now. Let yourself feel the grief and keep going.

Original post

How Does Pandemic Change the Big Picture? (Resilience.org)

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By Richard Heinberg, originally published by Resilience.org

March 25, 2020

As of 2019, the Big Picture for humanity was approximately as follows. Homo sapiens (that’s us), a big-brained bipedal mammal, had spent the Pleistocene epoch (from 2.5 million years ago until 12,000 years ago) developing its ability to control fire, talk, paint pictures, play bone flutes, and make tools and clothes. Language dramatically enhanced our sociality and helped enable us to invade and inhabit every continent except Antarctica. During the Holocene epoch (the last 12,000 years), we started living in permanent settlements, developed agriculture, and built state societies with kings, slavery, economic inequality, full-time division of labor, money, religions, and armies. The Anthropocene epoch (more of a brief interlude, really) dawned only a couple of centuries ago as we humans started using fossil fuels, which empowered us dramatically to grow our population and per capita consumption rates, mechanize production and transport, and basically dominate the entire planet. The mechanization of agriculture, by making the landed peasantry redundant, led to mass urbanization and quickly pumped up the size of the middle class. However, the use of fossil fuels destabilized the global climate, while also vastly increasing existing problems like pollution, resource depletion, and the destruction of habitat for most wild creatures. In addition, over the past few decades we learned how to use debt to transfer consumption from the future to the present, based on the risky assumption that the economy will continue to grow forever, thereby enabling future generations to pay for the lifestyle we enjoy now.

In short, the Big Picture was one of ever-increasing power and peril. Suddenly it has changed. A pattern of furious economic growth, consistent over many decades since the dawn of the Anthropocene (with only occasional interruptions, primarily consisting of the Great Depression and two World Wars), has slammed precipitously into the wall of pandemic (un)preparedness. In an effort to limit mortality from the novel coronavirus, governments around the world have put their economies into a state of suspended animation, telling most workers to stay home and to avoid direct contact with others.

How is this development impacting trends that were already underway? Will future generations look back on the coronavirus pandemic as a blip or a game changer? Let’s review a few of the major trends that developed during the Anthropocene and engage in a little informed speculation about how they might be affected by the COVID-19 outbreak.

Climate change: In China, lockdowns of workers and closures of companies have led to a dramatic reduction in greenhouse gas emissions. Over the coming weeks, emissions for the world as a whole could fall by ten percent or more. Note to climate warriors: don’t cheer too loudly; folks who are out of work won’t appreciate gloating greenies.

The world’s response to the coronavirus undermines the argument that governments cannot reduce carbon emissions because doing so would hurt their economies. Clearly, national leaders felt that the more immediate (though, in the larger scheme of things, much less significant) threat of pandemic justified shutting down commerce. Climate activists should now feel emboldened to make the following case: If economic degrowth is what it takes to preserve a habitable biosphere, then world leaders can and must find fair and humane ways to reduce society’s scale of energy usage, resource extraction, manufacturing, and waste dumping—all of which contribute to climate change.

However, the pandemic is not good news for the transition to renewable energy. Supply chains for solar and wind companies have been disrupted, and demand for new installations is down. And with super-cheap oil and gas in the offing (see “Resource Depletion,” below), market forces are likely to hinder rather than help both the renewables industry and the shift to electric cars.

Economic inequality: For the gig economy, and for people living paycheck to paycheck (which includes up to 74 percent of Americans earning hourly wages), the coronavirus lockdown is a catastrophe. Over the short term, existing economic inequalities will result in highly unequal levels of sacrifice and suffering. It may be relatively easy for low-wage workers to rationalize a mandated week or two at home as a forced vacation, but if tens of millions of Americans with no savings experience several months without income, regional social stresses could build to the breaking point. That’s one reason government officials are talking about cash handouts.

Over the longer term, recent absurd levels of inequality could get seriously snipped. In his book The Great Leveler, historian Walter Scheidel argues that, in the past, economic inequality has been reversed most dramatically by what he calls the “Four Horsemen”—mass mobilization for warfare, transformative revolution, state collapse, and plague. Currently many governments are undertaking economic re-allocation efforts equivalent in scale to those seen in the World Wars. For example, Denmark is paying 75 percent of wages (for salaries up to ~$50k/year) for companies that would otherwise have to lay off workers, for a period of three months. This not only enables quarantined workers to survive, but allows them to stay on the payroll and not have to go through a rehiring process later.

Thus, the current pandemic might arguably qualify as two of Scheidel’s Horsemen (mass mobilization and plague). The investor class is witnessing capital destruction at a prodigious rate and scale, while government efforts at maintaining civility and social well-being may entail providing a safety net for those with the least. Of course, this isn’t the way social justice advocates envisioned reining in inequality, but the result may end up being equivalent to another New Deal, and possibly even a Green New Deal.

Biodiversity loss: The novel coronavirus pandemic almost certainly began in wild animal markets in Wuhan, China. As Carl Safina put it in a recent article, “Humans caused the pandemic by putting the world’s animals into a cruel blender and drinking that smoothie.” While there have been other zoonotic epidemics in recent years, including HIV, the Marburg virus, SARS, and the 2009 H1N1 “swine flu” pandemic, the global coronavirus outbreak could provide a teachable moment, when wildlife conservation organizations can call successfully for an international moratorium on the trade or sale of any non-domesticated animal species (with zoos providing a highly regulated exception).

Otherwise, don’t expect much of a change in the overall declining trend in the numbers of insects, reptiles, amphibians, and wild birds and mammals with which we share this little planet.

Overpopulation: A few cynical millennials have called the novel coronavirus the “Boomer Remover” due to its tendency to attack the elderly with greatest virulence. Because humanity has recently been adding 80 million new members per year (births minus deaths), an erasure of one year’s net growth in population is possible in a worst-case scenario. However, the potential for a short-term moderation of our overall pattern of demographic expansion could be at least partly offset by the results, starting nine months from now, of hundreds of millions of people of reproductive age worldwide staying home for weeks with little to keep them busy. For wealthy nations with falling fertility levels, a much bigger threat to human population stability will likely continue to be posed by the buildup of endocrine-disrupting chemicals in the environment. For poor nations with high population growth trends, equal education opportunities for everyone regardless of gender will substantially help reduce growth rates.

Resource depletion: With manufacturing on the skids, demand and hence prices for most commodities are plummeting. The world’s most economically crucial commodity, oil, has seen its price fall from $50 a barrel to close to $20 (as of this writing); some analysts are forecasting prices in the single digits. With oil usage crashing, petroleum storage capacity will run out, at which point producers will have no choice but to mothball some oil wells. Oil companies will likely be bailed out, but cannot be profitable under current conditions. The prospect of ever ramping world oil extraction rates back up to recent levels seems dim. It is likely, then, that the long-anticipated moment of the world oil production peak has already occurred, with little fanfare, in November, 2018.

Of course, the blowout in oil markets is a result of economic disaster rather than sound policies of resource conservation. Therefore, adaptation on the part of industry and society as a whole will be chaotic. The international implications are fraught and hard to predict: several key Middle Eastern nations will see their economies shredded by low oil prices, and Great Powers (specifically, China and Russia) may seek to take advantage of the moment by seeking to realign alliances in the region.

Pollution: Marshall Burke of Stanford University has recently written that “the reductions in air pollution in China caused by this economic disruption likely saved 20 times more lives in China than have currently been lost due to infection with the virus in that country.” Reduced rates of manufacturing and consumption should help to reduce overall pollution, but of course this is the side effect of crisis, not the result of sound policy. Therefore, without environmental policy interventions, there’s no reason to expect pollution reduction benefits to be sustained. Just one example of how some temporary benefits could be balanced by new harms: The use of single-use plastics is likely to increase during the pandemic response.

Global debt bomb: The world economy is again in a deflationary moment, as it was in 1932 and 2008. For central banks and governments, all fiscal efforts will be geared toward re-inflating an economy that is otherwise hissing and flattening. There is a heightened risk that investors will realize that, in a no-growth world, their financial instruments are inherently worthless, forcing not just a collapse of the market value of stocks, but a repudiation of the very rules of the game. However, since the coronavirus epidemic itself will eventually subside, the more likely outcome is a period of defaults and bankruptcies mitigated by heroic levels of Fed bond purchases, and government bailouts (of the oil and airline industries, just for starters) and deficit spending. Eventually, if money printing goes exponential, hyperinflation is a possibility, but not soon. Big takeaway: the financial system has been destabilized and, like the oil industry, may never return to “normal.”

*          *          *

Let’s return to the question posed above: Will humanity look back on the coronavirus pandemic as a blip or a game changer? The likely answer depends partly on how long the pandemic lasts, and that, in turn, will depend largely on how soon tests become widely available, and when treatments and vaccines are found. US Government documents marked “not for public release” suggest significant shortages not just of medical equipment, but also of general goods over the next 18 months for government, industry, and private citizens, if solutions are not quickly forthcoming.

The level at which the game is changed also depends on the degree of downturn in employment and GDP. Fred Bullard, President of the St. Louis Fed, has gone on record saying that the US unemployment rate may hit 30 percent in the second quarter because of shutdowns to fight the coronavirus, and that GDP could drop 50 percent. This would be economic carnage far beyond the scale of the Great Depression (the United States unemployment rate in 1933 was 25 percent; its GDP fell an estimated 15 percent). If the global economy falls that far, and remains locked down even for a few weeks, label the coronavirus “game changer, big time.”

But a change to what? Dystopian possibilities come only too readily to mind. However, in conversation, some of my think-tank colleagues have suggested the pandemic could turn out to be a “Goldilocks” crisis that would disrupt the global order just enough, and in such a way, as to foster a response that sets at least some societies on a trajectory toward cooperation, redistribution, and degrowth.

First, governments often deal with shortages (foreseen in the report cited above) through the tried-and-true strategy of quota rationing. As Stan Cox details in his indispensable book Any Way You Slice It: The Past, Present, and Future of Rationing, quota rationing doesn’t always work well; but when it does, the results can be fairly admirable. During both World Wars, Americans participated enthusiastically in rationing programs for food, tires, clothing, and more. Britain continued its rationing programs well after the end of WWII, and surveys showed that, during the period of rationing, Britons were generally better fed and healthier than either before or after. In most imaginary scenarios for deliberate economic degrowth, quota rationing programs for energy and materials figure prominently.

Cox concludes that rationing programs tend to be more successful when people are united against a common enemy, and when shortages are believed to be temporary. Despite President Trump’s efforts to dub it the “Chinese virus,” SARS-Cov-2 has no inherent nationality, nor is it Democrat or Republican. It is indeed a common enemy, and people tend to become more cooperative when faced with a collective threat. Further, epidemiologists agree that the threat will have an end point, even if we don’t know exactly when that will be. Therefore, conditions for success in rationing exist, and rationing could help foster more communitarian and cooperative attitudes overall.

Also, as discussed above, the pandemic has the potential for significant economic leveling. Historically, not all leveling moments featured increased cooperation: when initiated by state collapse or transformative revolution, leveling has been accompanied by widespread suffering and bloody conflict. However, during the great leveling moments of the twentieth century—the Depression and the two World Wars—Americans managed to pull together with a sense of shared sacrifice.

Over the longer term, we are still faced with the challenges of climate change, resource depletion, overpopulation, pollution, and biodiversity loss. While the pandemic might have minor or temporary spinoff effects that ameliorate these problems, it won’t solve them. Significant, sustained collective effort will still be required to transform energy systems, economies, and lifestyles (though the pandemic could transform economies and lifestyles in unpredictable ways). If the coronavirus response puts us on a cooperative footing, all the better. Of course, that would be at the expense of currently unknown ultimate numbers of fatalities and sicknesses, as well as widespread fear and privation. The potential bits of silver I’ve mentioned are the linings of a cloud; but, as Monty Python can still remind us via YouTube, it’s always good to look on the bright side of life.

Coronavírus anuncia revolução no modo de vida que conhecemos (Folha de S.Paulo)

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www1.folha.uol.com.br

Domenico De Masi – 22.3.2020

[RESUMO] Sociólogo italiano narra situação dramática em seu país e argumenta que as imposições em decorrência da pandemia, como o trabalho em casa, a solidariedade e o papel da esfera pública, demonstram que é possível e desejável mudar a lógica mercadista da economia e criar modos de viver mais racionais e proveitosos para o mundo contemporâneo.

A Itália de onde escrevo, um dos países mais vivazes e alegres do mundo, é hoje apenas um deserto. Cada um dos seus 60 milhões de habitantes acha que é imortal, que o vírus não o tocará, que irá matar não ele mas alguma outra pessoa. Porém, no silêncio do seu coração, cada um sabe que essa ilusão é pueril e que essa pandemia misteriosa, abstrata e tangível ao mesmo tempo, escolhe suas vítimas ao acaso, como numa roleta russa.

Em algum tempo vamos saber se o vírus pode ser debelado ou se nos matará em massa, assim como fez no século passado a famosa gripe espanhola, que matou 1 milhão de pessoas por semana durante 25 semanas seguidas.

Moro há 50 anos no centro de Roma, na rua mais movimentada da cidade, que leva da praça Veneza à Basílica de São Pedro.

Normalmente, essa rua está 24 horas por dia entupida de trânsito, de turistas e peregrinos. Há duas semanas, está muda e deserta. Só de vez em quando ouve-se o grito de uma sirene de ambulância e algum sem-teto passa. A cidade inteira está fantasmagórica como a Los Angeles de “Blade Runner”. Aqui, porém, desapareceram até os replicantes extraterrestres.

Fechados os lugares públicos, as escolas, as fábricas, as lojas, as estações, os portos e os aeroportos, a Itália é agora um país separado do resto da Europa e do mundo. Cada cidade está parada, cada família trancafiada em casa. Quem sai à revelia dos pouquíssimos motivos permitidos é interceptado imediatamente pelas rondas policiais que aplicam penas bastante severas.

Os gregos antigos consideravam que, quando algo é indispensável e todavia impossível, a situação é trágica. Foram necessários 50 dias, milhares de doentes e mortos para que os italianos entendessem que a situação é, enfim, irremediavelmente trágica.

O que significa uma pandemia como essa para Roma, para a Itália, para a humanidade como um todo? Como ela age nas mentes e nos corações de todos nós que, armados com tecnologias poderosas e inteligência artificial, até poucas semanas atrás nos sentíamos os senhores do céu e da terra?

Subitamente nos descobrimos frágeis pigmeus diante da onipotência imaterial de um vírus que, por vias misteriosas, escapou de um morcego chinês para vir matar homens e mulheres em nossas cidades.

A sujeição a um vírus desconhecido, para o qual não há nem cura nem vacina, transformou a Itália numa enorme caserna blindada e os 60 milhões de italianos noutros tantos dóceis soldadinhos empenhados num gigantesco exercício militar no qual estão obrigados a aprender a verdade que antes ignoravam obstinadamente. O que não quer dizer que irão apreendê-la.

Numa Europa onde, até ontem, era permitida a livre circulação de pessoas, mercadorias e dinheiro, agora cada país, em vez de abraçar uma colaboração ainda mais solidária com os demais, tranca suas próprias fronteiras, iludindo-se de forma cínica e infantil que seja possível deter o vírus com barreiras aduaneiras.

Contudo, hoje, mais do que nunca, os soberanismos parecem tentativas fantasiosas contra a globalização. Hoje, mais do que nunca, a difusão da pandemia e sua rápida volta ao mundo demonstraram que deter a globalização é como se opor à força de gravidade. Nosso planeta já é aquela “aldeia global” da qual falava McLuhan, unida por infortúnios e pela vontade de viver, precisando de uma direção unitária, capaz de coordenar a ação sinérgica de todos os povos que desejam se salvar. Nessa aldeia global, nenhum homem, nenhum país é uma ilha.

Talvez tenhamos aprendido que o caso agora é de vida ou morte e que ninguém pode enfrentar sozinho um vírus tão ardiloso e potente. Por isso, são necessários recursos, inteligências, competências, ações e instituições coletivas. Coordenação e coesão geral. É necessária uma cabine de comando, um governo competente que tenha autoridade, uma equipe formada por um vértice político de grande inteligência e apoiada pelos máximos representantes das ciências médicas, da economia, da sociologia, da psicologia social e da comunicação.

Talvez tenhamos aprendido que os fatos e os dados devem prevalecer sobre as opiniões, a competência reconhecida deva prevalecer sobre o simples bom senso, a prudência e a gradualidade das intervenções devem prevalecer às tomadas de decisões arrogantes e à improvisação imprudente. Por outro lado, é necessário tolerar os erros de quem possui a responsabilidade terrível de tomar decisões, líder que deve ser generosamente amparado para que sejam melhoradas.

Talvez tenhamos aprendido que, perante um vírus desconhecido, assim como diante de um problema complexo, as decisões sobre a pandemia não apenas devem ser tomadas pelas pessoas competentes mas também ser comunicadas de forma unívoca, com autoridade, prontamente, de forma abrangente e clara. Todo o alarmismo, todo o exagero, toda a subestimação é terrível porque confunde as ideias e nos faz perder um tempo precioso. Carência e excesso de informações são parâmetros nocivos. Talk shows superficiais e fake news delirantes levam ao cinismo e à desumanização.

Talvez tenhamos aprendido que, nos países civilizados, o bem-estar é uma conquista irrenunciável. Por sorte e pela sabedoria dos nossos pais, a Constituição italiana de 1948 considera a saúde como um direito fundamental de cada ser humano. Já a reforma sanitária de 1978 instituiu um serviço nacional universal que considera a saúde não como meramente a ausência de doença, mas como o bem-estar físico, psíquico e social completo.

Graças a esse regime de saúde, todos os residentes (e também os turistas) fruem dos cuidados médicos sem qualquer custo. Isso nos possibilitou descobrir e curar prontamente os contágios e reduzir o número de mortes.

No país mais rico e mais poderoso do mundo, os EUA, onde o bem-estar é estupidamente mortificado, os suspeitos de Covid-19 precisam desembolsar o equivalente a 1.200 euros pelo teste. O vírus corona, ao se difundir, causaria uma verdadeira hecatombe entre 90 milhões de estadunidenses que, desprovidos de seguro-saúde, seriam cinicamente rejeitados pelos hospitais.

A propaganda neoliberal, que se alastrou sob a bandeira insana de Reagan e Thatcher, desacreditou tudo o que é público em favor do setor privado. Porém, pelo contrário, nessas semanas trágicas, a reação eficiente dos hospitais e dos funcionários públicos diante do surgimento da pandemia nos ensinou que a nossa saúde pública, da mesma forma que outras funções públicas, dispõe, muito mais do que o setor privado, de pessoas preparadas profissionalmente, motivadas e generosas até o heroísmo.

Toda noite, às 18h, todas as janelas da Itália se escancaram e cada um canta ou toca o hino nacional para agradecer aos médicos e a todos os profissionais da saúde.

A pandemia está nos ensinando que o pensamento de Keynes permanece precioso. Em 1980, o prêmio Nobel Robert Lucas Jr. observou: “Não é possível encontrar nenhum bom economista com menos de 40 anos que se diga ‘keynesiano’. Nas universidades, as teorias keynesianas não são levadas a sério e provocam sorrisinhos de superioridade”.

Hoje, essa crise histórica, com seus mortos e com suas tragédias, se porum lado nos leva à recessão, por outro nos lembra que, para evitar uma crise irreparável, em vez de políticas de austeridade, é preferível dar lugar aos investimentos públicos maciços e “open-ended”, ainda que isso leve ao déficit público.

Talvez tenhamos aprendido tudo isso e várias outras coisas com aquilo que ocorreu fora do recinto doméstico, isto é, entre o governo e todo o povo do país. Entretanto, hoje, a nossa vida está segregada entre as paredes domésticas. Todos estão restritos entre as quatro paredes da própria casa: não só as famílias que vivem em harmonia e acordo, mas também os solitários, os casais em crise e os núcleos familiares em que o diálogo entre pais e filhos há muito tempo andava claudicante.

A sociedade industrial nos habituara a separar o local de trabalho do local de vida, nos fazendo passar a maior parte do nosso tempo com chefes e colegas nas empresas: os que a sociologia chama de grupos “secundários”, frios, formais, nos quais as relações são quase exclusivamente profissionais. Uma parte mínima do nosso tempo nos via reunidos em família ou com os amigos, ou seja, com grupos “primários”, calorosos, informais, envolventes.

De repente, o descanso compulsório em casa nos obrigou de forma inédita ao isolamento total, a uma convivência forçada que para alguns parece agradável e tranquilizadora, mas que para outros é invasiva e até opressora. Os mais sortudos conseguem transformar o ócio depressivo em ócio criativo, conjugando a leitura, o estudo, o lúdico com a parcela de trabalho que é possível desempenhar em regime de “smart working”.

Sabíamos teoricamente que essa modalidade de trabalho à distância permite aos trabalhadores uma preciosa economia de tempo, dinheiro, stress e alienação; e às empresas, evita os microconflitos, despesas na manutenção do local de trabalho e promove incremento da eficiência, recuperando de 15 a 20% da produtividade; à coletividade, evita a poluição, o entupimento de trânsito e despesas de manutenção das estradas.

Agora que 10 milhões de italianos, forçados pelo vírus, rapidamente adotaram o teletrabalho, minimizando seu sentimento de inutilidade e os danos à economia nacional, nos perguntamos por que as empresas não haviam adotado antes uma forma de organização tão eficaz e enxuta. A resposta está naquilo que os antropólogos definem como “cultural gap” —lacuna cultural— das empresas, dos sindicatos, dos chefes.

O tempo livre que, até um mês atrás, nos parecia um luxo raro, hoje abunda. O espaço, que nas cidades vazias se dilatou, por sua vez falta nas casas. Por isso, estamos apreciando a ajuda que nos chega da internet, graças à qual, mesmo permanecendo forçosamente distantes, é possível nos reunirmos virtualmente, nos informarmos, nos confrontarmos, nos encorajarmos.

Nessa reclusão, os jovens têm a maior vantagem, graças à sua facilidade com os computadores, enquanto os velhos têm mais vantagem por serem mais independentes, mais acostumados a estar em casa, fazendo pequenos trabalhos e jogos sedentários, contentando-se com a televisão.

Em todos se insinua o medo de que, mais cedo ou mais tarde, possa terminar o abastecimento dos mantimentos. O colapso da economia torna-se cada vez mais inevitável, já que tanto a produção como o consumo encontram-se bloqueados.

Há alguns anos, Kennet Building, um dos pais da teoria geral dos sistemas, comentando a sociedade opulenta, afirmou: “Quem acredita na possibilidade do crescimento infinito num mundo finito ou é louco ou é economista”. E Serge Latouche acrescentou: “O drama é que agora somos todos mais ou menos economistas. Aonde estamos nos encaminhando? Diretamente contra um muro. Estamos a bordo de um bólido sem piloto, sem marcha a ré e sem freios que irá se chocar contra os limites do planeta”. Latouche propõe abandonar a sociedade de consumo com um decrescimento planificado, progressivo e sereno.

A marcha a ré e os freios que a cultura neoliberal se recusou obstinadamente a usar agora foram desencadeados: não graças a uma revolução violenta, mas sim a um vírus invisível que um morcego soprou sobre a sociedade opulenta, obrigando-a a se repensar.

“A Peste” (1947), obra-prima profética de Albert Camus, talvez possa nos ajudar nesse repensar. Naquele romance, a ciência era protagonista, ou seja, o médico Bernardo Rieux, ocupado até o fim, como médico e como homem, de socorrer os contagiados, enquanto “o cheiro de morte emburrecia todos os que não matava”.

Hoje, nós também, como o nosso tão humano irmão Rieux, estamos presos num limbo entre o pesar e a esperança, no qual temos que aprender que “a peste pode vir e ir embora sem que o coração do homem seja modificado”; que “o bacilo da peste não morre nem desaparece nunca, que pode permanecer adormecido por décadas nos móveis e nas roupas, que espera pacientemente nos quartos, nas adegas, nas malas, nos lenços e nos papéis, que talvez chegue o dia em que, infortúnio ou lição aos homens, a peste acordará seus ratos para mandá-los morrer numa cidade feliz”.

Domenico De Masi, sociólogo italiano, é autor dos livros “Ócio Criativo” e “O Futuro do Trabalho”.

Tradução de Francesca Cricelli.

Texto original

‘It’s OK to feel anxious.’ How a professor in China faced coronavirus disruptions and fears (Science)

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Robert Neubecker

By Kai Liu – Mar. 17, 2020 , 9:00 AM

In early February, I was working from home when I received a message informing me—and all the other professors at my university in China—that courses would be taught online because of the novel coronavirus. I was already feeling anxious about the mounting epidemic, and my university had locked its doors a few days earlier. Then, when I realized I’d have to teach students online, my anxiety level grew. I didn’t have any experience with online teaching platforms. I was also skeptical about how effective they’d be. “How will I gauge the students’ reactions to my lectures through a computer screen?” I wondered. “Will they learn anything?”

people sitting at a dinner table

I live in Xuzhou, China—roughly 500 kilometers from Wuhan, the epicenter of the COVID-19 pandemic. Unlike Wuhan, my city isn’t on lockdown, but residents have been discouraged from going outside and many businesses and institutions are closed. I’ve spent most of the past 2 months at home, along with my wife and daughter, fearful of the future and wondering when life will get back to normal.  

Thankfully, none of my family members, friends, or colleagues have tested positive for the novel coronavirus. Working from home is also possible for me because my research doesn’t involve lab work. But the spread of the virus and the rapidly rising death toll have weighed heavily on my mind. I’ve found it difficult to sleep. I’ve also had trouble focusing on work. One day early in the outbreak, I sat down at my computer intending to write a grant proposal. But all I could do was stare at the screen.

Years ago, I’d heard that Taoism philosophies were helpful for finding internal peace. So, I decided to listen to a few recordings. One instructed listeners to “govern [yourself] by doing nothing that goes against nature.” That resonated with me because I realized that I’d been trying to push my anxieties aside and force myself to concentrate on work—an approach that wasn’t working because it didn’t feel natural. From then on, I told myself that it was OK to feel anxious, even if it impeded my work. That helped to lessen my internal struggles.

Over the past 2 months, I’ve also learned how to teach courses online, and I have found unexpected joy in that process—even though I struggled at first. There were multiple online teaching platforms to choose from, and I didn’t know which one was best or how to use it. I opted for a platform that had a large server, thinking that it would cope better with heavy usage. My university provided some helpful guidance, and I also learned through trial and error.

I’ve spent most of the past 2 months at home … wondering when life will get back to normal.

My first lecture was especially difficult because I couldn’t see the students’ faces. I was accustomed to lecturing in front of an audience. Online, I felt like I was speaking at my students but not getting anything in return. I communicated with a few of them afterward to get their feedback and they agreed with me, saying that I needed to find a way to make my lectures more interactive. So, I started to encourage my students to leave questions for me in the platform’s comment section during my lectures.

Almost immediately, my students started peppering me with questions. I was surprised by the level of engagement. In a normal classroom setting, they are afraid to raise their hands; most wait until after the lecture is over to approach me and ask a question. But online, students were more comfortable sharing their questions in front of the entire class. That was a great outcome because if one student has a question, it’s likely that another student has the same question and would benefit from hearing the answer. I’ve also been pleased to see from the homework assignments that they are following my teaching well.

China was the first country to close its universities, but over the past month, universities in Italy, the United States, and elsewhere have made similar moves. I hope that my story can provide inspiration for academics who are fearful of what’s to come. It’s OK to feel anxious. But I’d also recommend staying open to change. You never know what you’ll learn.

Original publication

A Professor of Disasters and Health on Covid-19 (Nautilus)

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Posted By Ilan Kelman on Mar 16, 2020

It is no mystery why pandemics happen. Those with the knowledge, wisdom, and resources must choose to decide to avoid these disasters that afflict everyone.Photograph by Pavel L Photo and Video / Shutterstock

A new virus sweeps the world, closing borders, shutting down arts and sports, and killing thousands of people. Is this coronavirus pandemic, with the disease named Covid-19, simply a natural disaster, a culling of overpopulation as suggested by callous commentators who seem to revel in human misery? Is it nature’s rebuttal to human-caused climate change, forcing us to reduce fossil fuel-based transportation and overconsumption (apart from toilet paper)? The answer is neither. As with almost all disasters, the Covid-19 disaster is the outcome of human choices.

The Earth, with its microorganisms, tectonic activity, powerful weather, and other phenomena, has long posed dangers to humans. We know this, so it is up to us to deal with it. Sometimes we manage and sometimes we do not. Sometimes we are forced into situations with few choices, such as impoverished people living on the slopes of Mexico City’s volcano or in the subsiding floodplains of Jakarta. Not everyone can or should be a planner or engineer, to avoid houses built on soils prone to liquefying in an earthquake or offices lacking basic seismic reinforcement. Sometimes, we need to trust the zoning regulations and building codes—and their monitoring and enforcement—to keep us safe. Too often, gaps are revealed only after people have died, from the collapse of the CTV Building in Christchurch, New Zealand, during the 2011 earthquake, to New Orleans flooding during Hurricane Katrina in 2005. Those who suffer most, from Australia’s 2020 bushfires to Haiti’s 2010 earthquake, tend to have the fewest options for countering their vulnerabilities which were created by others.

We know that, by disturbing ecosystems, we make pandemics beyond Covid-19 more likely to occur.

When we are vulnerable to nature, it is because societal actions set people up to be harmed by nature. As we cannot blame nature for disasters, we should avoid the phrase “natural disaster.” They are just “disasters.” It could be shoddily built infrastructure, breaking or not having planning regulations, not being able to afford or not having insurance, poor communication of warnings, or fearing assault in an evacuation shelter. It is the same with disease. 

The World Health Organization of the United Nations was lambasted for being far too slow to observe and respond to what became the largest Ebola epidemic yet known, in West Africa between 2014 and 2016. In the years before, donor countries to the WHO had slashed the funds available, particularly hitting the division responsible for surveilling, monitoring, preparing for, and responding to possible epidemics. Experienced staff departed, communication lines to health systems around the world slackened, and institutional memory faded. Not that the UN’s organizations are perfect otherwise, displaying their own operational failings alongside geographic and cultural biases. Plus, many of the Ebola-struck countries—for instance, Guinea, Liberia, and Sierra Leone—have long lacked adequate health systems, with the governments mired in corruption, conflict, external exploitation, and incompetence. Deficient local, national, and international governance for epidemics meant that Ebola spread far faster and farther afield than it would have if health systems had been supported. A further illustration comes from infected people ending up in the United Kingdom and the United States, yet neither country experienced an Ebola outbreak nor was there ever a pandemic. When it was decided that the spread of Ebola should be stopped, knowledge, resources, and actions were harnessed to stop the spread of Ebola. Earlier choices in West Africa, especially long-term backing for health systems, would have curtailed the disease far sooner.

And so we come to Covid-19. When a strange form of pneumonia appeared in patients in Wuhan, China in December 2019, medical staff reported it and soon identified the origin in one market. They isolated the new virus and publicly announced its genetic sequence. Authorities gave assurances that transmission between humans was not possible and that the virus was under control, despite evidence that neither was the case. Medical staff in Wuhan noticing the sickness explained that they were not permitted to broadcast their knowledge about it. Ai Fen, an emergency department doctor, was reprimanded and told to keep quiet. An ophthalmologist, Li Wenliang, was intimidated and silenced. He eventually died of coronavirus, with the media adorning him with the poignant label of “whistle blower.”

It is a choice to institute what is now referred to as a “cover up” when a potential public health threat emerges. It is a choice not to listen to health professionals hired in key positions when they are trying to save lives through public health measures. It is a choice to have opaque dissemination procedures and to try to shut down information flow. Now that the pandemic has been created by choices early on, it is a choice that many others are making to panic-buy soap while others are not bothering to wash their hands properly or to stop touching their food or face with unwashed hands. So much of disease is about human behavior. This in no way diminishes the importance of the essential medical responses. Without vaccines, smallpox, polio, rinderpest, measles, mumps, and a whole host of other lethal diseases would continue to run rampant. Along with antibiotics and other pharmaceuticals, vaccines not only save lives daily, but also reduce the costs of running health systems by stopping illness.

Health systems must have technologies and tools—dialysis machines, isolation wards, defibrillators, and stents within the dizzying array—but must not stop at technical means and buildings. Any health system must be underpinned by people, training, and experience—exactly what many of the authorities disdained when people in Wuhan suddenly fell ill. Earlier choices in China might have curtailed the spread of Covid-19 before it morphed into a pandemic. Even basic hygiene when dealing with animals might have prevented the virus from jumping species to humans.

Today, diseases targeted for eradication include rubella, measles, dracunculiasis (Guinea worm disease), and polio. The latter two remain endemic in conflict zones, often reappearing due to war, like polio did in 2013, in Syria, where it had disappeared a decade previously. Similarly, dracunculiasis is close to being eradicated, stubbornly remaining in areas wracked by violence including Chad and South Sudan. Choices to target these diseases are nonetheless preventing epidemics of them, with eradication in sight. London and Paris famously eliminated cholera in the 19th century by building sewage systems, among other actions. Malaria used to be prevalent in southern England and across the US. Dedicated efforts eradicated it and continue to prevent its re-introduction, despite cases from travelers and near international airports. We can continue these efforts by choice or we can let malaria return.

We know that, by disturbing ecosystems, we make pandemics beyond Covid-19 more likely to occur. “In Africa, we see a lot of incursion driven by oil or mineral extraction in areas that typically had few human populations,” Dennis Carroll, an infectious disease researcher, told Nautilus editor Kevin Berger. “The problem is not only moving workers and establishing camps in these domains, but building roads that allow for even more movement of populations. Roads also allow for the movement of wildlife animals, which may be part of a food trade, to make their way into urban settlements. All these dramatic changes increase the potential spread of infection.” It is no mystery why pandemics happen. Those with the knowledge, wisdom, and resources must choose to decide to avoid these disasters that afflict everyone.

Ilan Kelman is Professor of Disasters and Health at University College London and the author of Disaster By Choice: How Our Actions Turn Natural Hazards into Catastrophes. Follow him on Twitter/Instagram @IlanKelman.

Argentine and Brazilian doctors suspect mosquito insecticide as cause of microcephaly (The Ecologist)

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Claire Robinson / GMWatch

10th February 2016

With the proposed connection between the Zika virus and Brazil’s outbreak of microcephaly in new born babies looking increasingly tenuous, Latin American doctors are proposing another possible cause: Pyriproxyfen, a pesticide used in Brazil since 2014 to arrest the development of mosquito larvae in drinking water tanks. Might the ‘cure’ in fact be the poison?

Malformations detected in thousands of children from pregnant women living in areas where the Brazilian state added Pyriproxyfen to drinking water are not a coincidence, even though the Ministry of Health places direct blame on the Zika virus.

The World Health Organization view that the microcephaly outbreak in Brazil’s impoverished northeast is caused by the Zika virus has, so far, received few challenges.

Brazil’s Health Minister, Marcelo Castro, has gone so far as to say that he has “100% certainty”that there is a link between Zika and microcephaly, a birth defect in which babies are born with small heads.

The view is widely supported in the medical community worldwide, including by the US’s influential Center for Disease Control. But there is no hard evidence of the link, rather a mixture of epidemiological indications and circumstantial evidence.

One of the key scientific papers, by A S Oliveira Melo et al in the journal Ultrasound in Obstetrics & Gynecology, found Zika virus in the amniotic fluids and other tissues of the affected babies and their mothers. But only two women were examined, far too small a number to establish a statistically significant link.

The New York Times also reported on 3rd February on the outcome of analyses by Brazil’s Health Ministry: “Of the cases examined so far, 404 have been confirmed as having microcephaly. Only 17 of them tested positive for the Zika virus. But the government and many researchers say that number may be largely irrelevant, because their tests would find the presence of the virus in only a tiny percentage of cases.”

And last weekend, the most powerful indicator yet that the microcephaly may have another cause altogether was announced by Colombia’s president, Juan Manuel Santos, as reported by the Washington Post. Colombian public health officials, stated Santos, have so far diagnosed 3,177 pregnant women with the Zika virus- but in no case had microcephaly been observed in the foetus.

Argentine doctors: it’s the insecticide

Now a new report has been published by the Argentine doctors’ organisation, Physicians in the Crop-Sprayed Towns (PCST), [1] which not only challenges the theory that the Zika virus epidemic in Brazil is the cause of the increase in microcephaly among newborns, but proposes an alternative explanation.

According to PCST, the Ministry failed to recognise that in the area where most sick people live, a chemical larvicide that produces malformations in mosquitoes was introduced into the drinking water supply in 2014.

This pesticide, Pyriproxyfen, is used in a state-controlled programme aimed at eradicating disease-carrying mosquitos. The Physicians added that the Pyriproxyfen is manufactured by Sumitomo Chemical, a Japanese ‘strategic partner‘ of Monsanto. – a company they have learned to distrust due to the vast volume of the company’s pesticides sprayed onto Argentina’s cropland.

Pyriproxyfen is a growth inhibitor of mosquito larvae, which alters the development process from larva to pupa to adult, thus generating malformations in developing mosquitoes and killing or disabling them. It acts as an insect juvenile hormone or juvenoid, and has the effect of inhibiting the development of adult insect characteristics (for example, wings and mature external genitalia) and reproductive development.

The chemical has a relatively low risk profile as shown by its WHO listing, with low acute toxicity. Tests carried out in a variety of animals by Sumitomo found that it was not a teratogen (did not cause birth defects) in the mammals it was tested on. However this cannot be taken as a completely reliable indicator of its effects in humans – especially in the face of opposing evidence.

The PCST commented: “Malformations detected in thousands of children from pregnant women living in areas where the Brazilian state added Pyriproxyfen to drinking water are not a coincidence, even though the Ministry of Health places a direct blame on the Zika virus for this damage.”

They also noted that Zika has traditionally been held to be a relatively benign disease that has never before been associated with birth defects, even in areas where it infects 75% of the population.

Brazilian doctors also suspect pyriproxyfen

Pyriproxyfen is a relatively new introduction to the Brazilian environment; the microcephaly increase is a relatively new phenomenon. So the larvicide seems a plausible causative factor in microcephaly – far more so than GM mosquitos, which some have blamed for the Zika epidemic and thus for the birth defects.

The PCST report, which also addresses the Dengue fever epidemic in Brazil, concurs with the findings of a separate report on the Zika outbreak by the Brazilian doctors’ and public health researchers’ organisation, Abrasco. [2]

Abrasco also names Pyriproxyfen as a possible cause of the microcephaly. It condemns the strategy of chemical control of Zika-carrying mosquitoes, which it says is contaminating the environment as well as people and is not decreasing the numbers of mosquitoes.

Instead Abrasco suggests that this strategy is in fact driven by the commercial interests of the chemical industry, which it says is deeply integrated into the Latin American ministries of health, as well as the World Health Organization and the Pan American Health Organisation.

Abrasco names the British GM insect company Oxitec as part of the corporate lobby that is distorting the facts about Zika to suit its own profit-making agenda. Oxitec sells GM mosquitoes engineered for sterility and markets them as a disease-combatting product – a strategy condemned by the Argentine Physicians as “a total failure, except for the company supplying mosquitoes.”

Both the Brazilian and Argentine doctors’ and researchers’ associations agree that poverty is a key neglected factor in the Zika epidemic. Abrasco condemned the Brazilian government for its “deliberate concealment” of economic and social causes: “In Argentina and across America the poorest populations with the least access to sanitation and safe water suffer most from the outbreak.” PCST agrees, stating, “The basis of the progress of the disease lies in inequality and poverty.”

Abrasco adds that the disease is closely linked to environmental degradation: floods caused by logging and the massive use of herbicides on (GM) herbicide-tolerant soy crops – in short, “the impacts of extractive industries.”

The notion that environmental degradation may a factor in the spread of Zika finds backing in the view of Dino Martins, PhD, a Kenyan entomologist. Martins said that “the explosion of mosquitoes in urban areas, which is driving the Zika crisis” is caused by “a lack of natural diversity that would otherwise keep mosquito populations under control, and the proliferation of waste and lack of disposal in some areas which provide artificial habitat for breeding mosquitoes.”

Community-based actions

The Argentine Physicians believe that the best defence against Zika is “community-based actions”. An example of such actions is featured in a BBC News report on the Dengue virus in El Salvador.

A favourite breeding place for disease-carrying mosquitoes is storage containers of standing water. El Salvadorians have started keeping fish in the water containers, and the fish eat the mosquito larvae. Dengue has vanished along with the mosquitoes that transmit the disease. And so far, the locals don’t have any Zika cases either.

Simple yet effective programmes like this are in danger of being neglected in Brazil in favour of the corporate-backed programmes of pesticide spraying and releasing GM mosquitoes. The latter is completely unproven and the former may be causing far more serious harm than the mosquitoes that are being targeted.

 

 

Claire Robinson is an editor at GMWatch.

This article was originally published by GMWatch. This version includes additional reporting by The Ecologist.

Notes

1. ‘Report from Physicians in the Crop-Sprayed Towns regarding Dengue-Zika, microcephaly, and mass-spraying with chemical poisons‘. 2016. Physicians in the Crop-Sprayed Towns.

2. ‘Nota técnica e carta aberta à população: Microcefalia e doenças vetoriais relacionadas ao Aedes aegypti: os perigos das abordagens com larvicidas e nebulização química – fumacê‘. January 2016. GT Salud y Ambiente. Asociación Brasileña de Salud Colectiva. ABRASCO.

 

OMS declara vírus zica e microcefalia ‘emergência pública internacional’ (JC)

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Comitê de Emergência se reuniu pela primeira vez nesta segunda-feira (1) para reagir ao aumento do número de casos de desordens neurológicas e malformações congênitas, sobretudo nas Américas. País mais atingido é o Brasil

A Organização Mundial da Saúde (OMS) realizou nesta segunda-feira (1) a primeira reunião do Comité de Emergência que trata dos recentes casos de microcefalia e outros distúrbios neurológicos em áreas afetadas pelo vírus zika, sobretudo nas Américas. O país mais atingido é o Brasil.

O Secretariado da OMS informou ao Comitê sobre a situação dos casos de microcefalia e Síndrome de Guillain-Barré, circunstancialmente associados à transmissão do vírus zika. O Comitê foi recebeu informações sobre a história do vírus zika, sua extensão, apresentação clínica e epidemiologia.

As representações do Brasil, França, Estados Unidos e El Salvador apresentaram as primeiras informações sobre uma potencial associação entre a microcefalia – bem como outros distúrbios neurológicos – e a doença provocada pelo vírus zika.

Segundo o comunicado da OMS, os especialistas reunidos em Genebra concordam que uma relação causal entre a infecção do zika durante a gravidez e microcefalia é “fortemente suspeita”, embora ainda não comprovada cientificamente.

A falta de vacinas e testes de um diagnóstico rápido e confiável, bem como a ausência de imunidade da população em países recém-afetados, foram citadas como novos motivos de preocupação.

Para a Comissão da OMS, o recente conjunto de casos microcefalia e outros distúrbios neurológicos relatados no Brasil, logo após ocorrências semelhantes na Polinésia Francesa, em 2014, constituem uma “emergência de saúde pública de importância internacional”, condição conhecida também pela sua sigla em inglês (PHEIC).

Em uma decisão aceita pela diretora-geral da OMS, Margaret Chan, o Comitê da agência da ONU busca assim coordenar uma resposta global de modo a minimizar a ameaça nos países afetados e reduzir o risco de propagação internacional.

Recomendações à diretora-geral da OMS

O Comitê, em resposta às informações fornecidas, fez recomendações à OMS sobre medidas a serem tomadas.

Em relação aos distúrbios neurológicos e microcefalia, o Comitê sugere que a vigilância de microcefalia e da Síndrome de Guillain-Barré deve ser padronizada e melhorada, particularmente em áreas conhecidas de transmissão do vírus zika, bem como em áreas de risco de transmissão.

O Comitê também recomendou que seja intensificada a investigação acerca da etiologia – a causa das doenças – nos novos focos onde ocorrem os casos de distúrbios neurológicos e de microcefalia, para determinar se existe uma relação causal entre o vírus zika e outros fatores desconhecidos.

Como estes grupos se situam em áreas recém-infectadas com o vírus zika, de acordo com as boas práticas de saúde pública e na ausência de outra explicação para esses agrupamentos, o Comitê destaca a importância de “medidas agressivas” para reduzir a infecção com o vírus zika, especialmente entre as mulheres grávidas e mulheres em idade fértil.

Como medida de precaução, o Comitê fez as seguintes recomendações adicionais:

Transmissão do vírus zika

A vigilância para infecção pelo vírus zika deve ser reforçada, com a divulgação de definições de casos padrão e diagnósticos para áreas de risco.

O desenvolvimento de novos diagnósticos de infecção pelo vírus zika devem ser priorizados para facilitar as medidas de vigilância e de controle.

A comunicação de risco deve ser reforçada em países com transmissão do vírus zika para responder às preocupações da população, reforçar o envolvimento da comunidade, melhorar a comunicação e assegurar a aplicação de controle de vetores e medidas de proteção individual.

Medidas de controle de vetores e medidas de proteção individual adequada devem ser agressivamente promovidas e implementadas para reduzir o risco de exposição ao vírus zika.

Atenção deve ser dada para assegurar que as mulheres em idade fértil e mulheres grávidas em especial tenham as informações e materiais necessários para reduzir o risco de exposição.

As mulheres grávidas que tenham sido expostas ao vírus zika devem ser aconselhadas e acompanhadas por resultados do nascimento com base na melhor informação disponível e práticas e políticas nacionais.

Medidas de longo prazo

Esforços de pesquisa e desenvolvimento apropriados devem ser intensificados para vacinas, terapias e diagnósticos do vírus zika.

Em áreas conhecidas de transmissão do vírus zika, os serviços de saúde devem estar preparados para o aumento potencial de síndromes neurológicas e/ou malformações congênitas.

Medidas de viagem

Não deve haver restrições a viagens ou ao comércio com países, regiões e/ou territórios onde esteja ocorrendo a transmissão do vírus zika.

Viajantes para áreas com transmissão do vírus zika devem receber informações atualizadas sobre os potenciais riscos e medidas adequadas para reduzir a possibilidade de exposição a picadas do mosquito.

Recomendações da OMS sobre padrões em matéria de desinfestação de aeronaves e aeroportos devem ser implementadas.

Compartilhamento de dados

As autoridades nacionais devem garantir a comunicação e o compartilhamento ágeis e em tempo de informações relevantes de importância para a saúde pública, para esta Emergência.

Dados clínicos, virológicos e epidemiológicos, relacionados com o aumento das taxas de microcefalia e/ou Síndrome de Guillain-Barré, ou com a transmissão do vírus zika, devem ser rapidamente compartilhados com a OMS para facilitar a compreensão internacional destes eventos, para orientar o apoio internacional para os esforços de controle, priorizando a pesquisa e desenvolvimento de produtos.

Acompanhe:

http://who.int/emergencies/zika-virus

http://new.paho.org/bra

http://combateaedes.saude.gov.br

http://bit.ly/zikaoms

ONU

 

Leia também:

Agência Brasil – Notificação de casos de Zika passa a ser obrigatória no Brasil

Ebola Is Wiping Out the World’s Gorillas (The Daily Beast)

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Finbarr O’Reilly/Reuters

01.22.15

In just four decades, Ebola has wiped out one third of the world’s chimp and gorilla populations. If it continues, the results will be devastating.

While coverage of the current Ebola epidemic in West Africa remains centered on the human populations in Guinea, Sierra Leone, and Liberia, wildlife experts’ concern is mounting over the virus’ favorite victims: great apes.

Guinea, where the epidemic originated, has the largest population of chimpanzees in all of West Africa. Liberia is close behind. Central Africa is home to western lowland gorillas, the largest and most widespread of all four species. Due to forest density, the number of those infected is unknown. But with hundreds of thousands of ape casualties from Ebola, it’s doubtful they’ve escaped unscathed.

Animal activists are ramping up efforts to find an Ebola vaccine for great apes, but with inadequate international support for human research, their mission could be seen as competing with one to save humans. Experts from the Jane Goodall Institute of Canada insist such apprehension would be misplaced. Two streams of funding—one for humans, one for apes—can coexist in this epidemic, they assert, and must.

“The media was really focusing on human beings,” Sophie Muset, project manager for JGI, says. “But it has been traumatic to [the great ape] population for many years.”

Over the course of just four decades, Ebola has wiped out one third of the world’s population of chimpanzees and gorillas, which now stand at less than 300,000 and 95,000 respectively.

The first large-scale “die-offs” due to Ebola began in the late 1990s, and haven’t stopped. Over the course of just four decades, Ebola has wiped out one third of the world’s population of chimpanzees and gorillas, which now stand at less than 300,000 and 95,000 respectively. Both species are now classified as endangered by the International Union for Conservation of Nature; western gorillas are “critically” so.

One of earliest Ebola “die-offs” of great apes came in 1994, when an Ebola outbreak in Minkébé decimated the region’s entire population—once the second largest in the world. In 2002, an outbreak in the Democratic Republic of Congo wiped out 95 percent of the region’s gorilla population. And an equally brutal attack broke out in 2006, when Ebola Zaire in Gabon (the same strain as the current outbreak) left an estimated 5,000 gorillas dead.

The dwindling population of both species, combined with outside poaching threats, means Ebola poses a very real threat to their existence. To evaluate the damage thus far, the Wild Chimpanzee Foundation is conducting population assessments in West Africa, with the goal of getting a rough estimate of how many have died. Given the combined damage that Ebola has inflicted on this population, the results are likely to be troubling.

In a way, great apes are Ebola’s perfect victims. Acutely tactile mammals, their dynamic social environments revolve around intimacy with each other. Touching hands, scratching backs, hugging, kissing, and tickling, they are near constantly intertwined—giving Ebola a free ride.

In a May 2007 study from The American Naturalist, researchers studying the interactions between chimpanzees and gorillas found evidence the Ebola can even spread between the social groups. At three different sites in northern Republic of Congo, they found bacteria from gorillas and chimps on the same fruit trees. For a virus that spreads through bodily fluids, this is an ideal scenario.

“They live in groups [and] they are very close,” says Muset, who has worked with chimps on the ground in Uganda and the DRC. “Since Ebola transmission happens through body fluids, it spreads very fast.”

For gorillas in particular, this culture proves deadly, making their mortality rate for this virus closer to  95 percent. But like humans, the corpses of chimpanzees and gorillas remain contagious with Ebola for days. While the chimps and gorillas infected with Ebola will likely die in a matter of days, the virus can live on in their corpse for days—in turn, spreading to humans who eat or touch their meat.

It is one such interaction that could result in the spread from apes to humans. But in this particular outbreak, experts have zeroed in on the fruit bat (believed to be the original carrier) as the source. The index patient, a 2-year-old in Guinea, was reportedly playing on a tree with a fruit bat colony.

Whether or not a great ape was involved in the transmission of the virus to humans during this outbreak is unknown. Such an interaction is possible. Interestingly, however, it’s not the risk that great apes with Ebola pose to humans that wildlife experts find most concerning. It’s the risk that their absence poses to the wild.

Owing to a diet consisting mostly of fruit, honey, and leaves, gorillas and chimpanzees are crucial to forest life. Inadvertently distributing seeds and pollen throughout the forest, they stimulate biodiversity within it. Without them, the biodiversity of the vegetation may plummet, endangering all of the species that relied on it—and, in turn, the people that relied on them.

“They are not the only ones who act as seed dispersers,” says Muset. “But they are the big players in that field. So when [a die-off] happens, it can decimate an entire forest.”

Wildlife experts worldwide are working to raise both awareness and funds for a vaccination process. It’s a battle that she says was gaining speed last January, when a researcher announced that he had found a vaccine that could work in chimps But as the epidemic in West Africa grew, the focus shifted.

But Muset says its time to return to the project. “There is a vaccine, but it has never been tested on chimpanzees,” she says.  “Progress has been made, and preliminary testing done, but testing in the field need to happen to make it real.”

As to the question of whether it’s ethical to be searching for a vaccine for wild animals when humans are still suffering as well, Muset is honest. “For sure there is a direct competition here. But wildlife and humans have a lot of diseases in common that they can transmit from one to the other,” she says. “And I think you can think of it as two streams of funding, one to wildlife and the other to human beings.”

While it’s great apes that wildlife experts are seeking to save, human nature as a whole, Muset argues, is at stake. “If you want a healthy ecosystem, the more you have to invest in health for wildlife and humans,” she says. “Then, the better place it will be.  Because really, it all works together.”

Without swift influx of substantial aid, Ebola epidemic in Africa poised to explode (Science Daily)

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Date: October 23, 2014

Source: Yale University

Summary: The Ebola virus disease epidemic already devastating swaths of West Africa will likely get far worse in the coming weeks and months unless international commitments are significantly and immediately increased, new research predicts.

Artist’s conception (stock illustration). Credit: © Jim Vallee / Fotolia

The Ebola virus disease epidemic already devastating swaths of West Africa will likely get far worse in the coming weeks and months unless international commitments are significantly and immediately increased, new research led by Yale researchers predicts.

The findings are published in the Oct. 24 issue of The Lancet Infectious Diseases.

A team of seven scientists from Yale’s Schools of Public Health and Medicine and the Ministry of Health and Social Welfare in Liberia developed a mathematical transmission model of the viral disease and applied it to Liberia’s most populous county, Montserrado, an area already hard hit. The researchers determined that tens of thousands of new Ebola cases — and deaths — are likely by Dec. 15 if the epidemic continues on its present course.

“Our predictions highlight the rapidly closing window of opportunity for controlling the outbreak and averting a catastrophic toll of new Ebola cases and deaths in the coming months,” said Alison Galvani, professor of epidemiology at the School of Public Health and the paper’s senior author. “Although we might still be within the midst of what will ultimately be viewed as the early phase of the current outbreak, the possibility of averting calamitous repercussions from an initially delayed and insufficient response is quickly eroding.”

The model developed by Galvani and colleagues projects as many as 170,996 total reported and unreported cases of the disease, representing 12% of the overall population of some 1.38 million people, and 90,122 deaths in Montserrado alone by Dec. 15. Of these, the authors estimate 42,669 cases and 27,175 deaths will have been reported by that time.

Much of this suffering — some 97,940 cases of the disease — could be averted if the international community steps up control measures immediately, starting Oct. 31, the model predicts. This would require additional Ebola treatment center beds, a fivefold increase in the speed with which cases are detected, and allocation of protective kits to households of patients awaiting treatment center admission. The study predicts that, at best, just over half as many cases (53,957) can be averted if the interventions are delayed to Nov. 15. Had all of these measures been in place by Oct. 15, the model calculates that 137,432 cases in Montserrado could have been avoided.

There have been approximately 9,000 reported cases and 4,500 deaths from the disease in Liberia, Sierra Leone, and Guinea since the latest outbreak began with a case in a toddler in rural Guinea in December 2013. For the first time cases have been confirmed among health-care workers treating patients in the United States and parts of Europe.

“The current global health strategy is woefully inadequate to stop the current volatile Ebola epidemic,” co-author Dr. Frederick Altice, professor of internal medicine and public health added. “At a minimum, capable logisticians are needed to construct a sufficient number of Ebola treatment units in order to avoid the unnecessary deaths of tens, if not hundreds, of thousands of people.”

Other authors include lead author Joseph Lewnard, Martial L. Ndeffo Mbah, Jorge A. Alfaro-Murillo, Luke Bawo, and Tolbert G. Nyenswah.

The National Institutes of Health funded the study.

Journal Reference:

  1. Joseph A Lewnard, Martial L Ndeffo Mbah, Jorge A Alfaro-Murillo, Frederick L Altice, Luke Bawo, Tolbert G Nyenswah, Alison P Galvani. Dynamics and control of Ebola virus transmission in Montserrado, Liberia: a mathematical modelling analysis. Lancet Infectious Diseases, October 24, 2014 DOI:10.1016/S1473-3099(14)70995-8

Cruz Vermelha prevê ao menos quatro meses para controlar ebola (Agência Brasil)

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A epidemia já causou mais de 4,5 mil mortes na África Ocidental

A epidemia de ebola vai demorar pelo menos quatro meses para ser contida se todas as medidas necessárias forem tomadas, disse hoje (22) o responsável geral da Cruz Vermelha, Elhadj As Sy, alertando para “o preço da inação”. A epidemia já causou mais de 4,5 mil mortes na África Ocidental e os especialistas alertam que a taxa de infecção poderá chegar a 10 mil por semana no início de dezembro.

Ainda não há vacina aprovada para o ebola, que também atingiu profissionais da saúde na Espanha e nos Estados Unidos.

Elhadj As Sy listou uma série de medidas que poderiam ajudar a colocar o ebola sob controle, incluindo “um bom isolamento, bom tratamento dos casos confirmados, e bom, seguro e digno enterro às pessoas falecidas”. “Será possível, como era possível no passado, conter esta epidemia dentro de quatro a seis meses” se a resposta for adequada, acrescentou.

“Eu acho que esta é a nossa melhor perspectiva e nós estamos fazendo todo o possível para mobilizar nossos recursos e nossas capacidades para travar o surto”, destacou. As Sy, que falava em uma conferência da Cruz Vermelha da Ásia-Pacífico, acrescentou que “há sempre um preço pela inação”.

Novas medidas serão adotadas hoje nos Estados Unidos, entre as quais os voos dos países mais afetados – Libéria, Serra Leoa e Guiné-Conacri – serão encaminhados para cinco aeroportos e os passageiros passarão por exames mais completos de saúde.

Entretanto, especialistas que escrevem para a revista The Lancet, disseram, na terça-feira (21), que a triagem dos passageiros nos aeroportos de saída seria uma opção melhor do que monitorá-los no destino da viagem.

(Agência Lusa / Agência Brasil)

http://agenciabrasil.ebc.com.br/internacional/noticia/2014-10/cruz-vermelha-serao-necessarios-pelo-menos-quatro-meses-para-controlar

The Most Terrifying Thing About Ebola (Slate)

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The disease threatens humanity by preying on humanity.

By

SEPT. 19 2014 12:13 PM

Photo by John Moore/Getty ImagesSuspected Ebola patient Finda “Zanabo” prays over her sick family members before being admitted to the Doctors Without Borders Ebola treatment center on Aug. 21, 2014, near Monrovia, Liberia. Photo by John Moore/Getty Images

As the Ebola epidemic in West Africa has spiraled out of control, affecting thousands of Liberians, Sierra Leonians, and Guineans, and threatening thousands more, the world’s reaction has been glacially, lethally slow. Only in the past few weeks have heads of state begun to take serious notice. To date, the virus has killed more than 2,600 people. This is a comparatively small number when measured against much more established diseases such as malaria,HIV/AIDS, influenza, and so on, but several factors about this outbreak have some of the world’s top health professionals gravely concerned:

  • Its kill rate: In this particular outbreak, a running tabulation suggests that 54 percent of the infected die, though adjusted numbers suggest that the rate is much higher.
  • Its exponential growth: At this point, the number of people infected is doubling approximately every three weeks, leading some epidemiologists to projectbetween 77,000 and 277,000 cases by the end of 2014.
  • The gruesomeness with which it kills: by hijacking cells and migrating throughout the body to affect all organs, causing victims to bleed profusely.
  • The ease with which it is transmitted: through contact with bodily fluids, including sweat, tears, saliva, blood, urine, semen, etc., including objects that have come in contact with bodily fluids (such as bed sheets, clothing, and needles) and corpses.
  • The threat of mutation: Prominent figures have expressed serious concerns that this disease will go airborne, and there are many other mechanisms through which mutation might make it much more transmissible.

Terrifying as these factors are, it is not clear to me that any of them capture what is truly, horribly tragic about this disease.

The most striking thing about the virus is the way in which it propagates. True, through bodily fluids, but to suggest as much is to ignore the conditions under which bodily contact occurs. Instead, the mechanism Ebola exploits is far more insidious. This virus preys on care and love, piggybacking on the deepest, most distinctively human virtues. Affected parties are almost all medical professionals and family members, snared by Ebola while in the business of caring for their fellow humans. More strikingly, 75 percent of Ebola victims are women, people who do much of the care work throughout Africa and the rest of the world. In short, Ebola parasitizes our humanity.

More than most other pandemic diseases (malaria, cholera, plague, etc.) and more than airborne diseases (influenza, swine flu, H5N1, etc.) that are transmitted indiscriminately through the air, this disease is passed through very minute amounts of bodily fluid. Just a slip of contact with the infected party and the caregiver herself can be stricken.

The images coming from Africa are chilling. Little boys, left alone in the street without parents, shivering and sick, untouchable by the throngs of people around them. Grown men, writhing at the door to a hospital, hoping for care as their parents stand helplessly, wondering how to help. Mothers and fathers, fighting weakness and exhaustion to move to the edge of a tent in order to catch a distant, final glimpse of a get-well video that their children have made for them.

If Ebola is not stopped, this disease can destroy whole families within a month, relatives of those families shortly thereafter, friends of those relatives after that, and on and on. As it takes hold (and it is taking hold fast), it cuts out the heart of family and civilization. More than the profuse bleeding and high kill rate, this is why the disease is terrifying. Ebola sunders the bonds that make us human.

Aid providers are now working fastidiously to sever these ties themselves, fighting hopelessly against the natural inclinations that people have to love and care for the ill. They have launched aggressive public information campaigns, distributedupdates widely, called for more equipment and gear, summoned the military, tried to rein in the hysteria, and so on. Yet no sheet of plastic or latex can disrupt these human inclinations.

Such heroic efforts are the appropriate medical response to a virulent public health catastrophe. The public health community is doing an incredible job, facing unbelievable risks, relying on extremely limited resources. Yet these efforts can only do half of the work. Infected parties—not all, to be sure, but some (enough)—cannot abide by the rules of disease isolation. Some will act without donning protective clothing. Some will assist without taking proper measures. And still others will refuse to enter isolation units because doing so means leaving their families and their loved ones behind, abandoning their humanity, and subjecting themselves to the terror of dying a sterile, lonely death.

It is tempting, at these times, to focus on the absurd and senseless actions of a few. One of the primary vectors in Sierra Leone is believed to have been a traditional healer who had been telling people that she could cure Ebola. In Monrovia a few weeks back, angry citizens stormed a clinic and removed patients from their care. “There is no Ebola!” they are reported to have been shouting. More recently, the largest newspaper in Liberia published an article suggesting that Ebola is a conspiracy of the United States, aimed to undermine Africa. And, perhaps even more sadly, a team of health workers and journalists was just brutally murdered in Guinea. It is easy, in other words, to blame the spread on stupidity, or illiteracy, or ritualism, or conspiracy theories, or any number of other irrational factors.

Photo by John Moore/Getty ImagesA man checks on a very sick Saah Exco, 10, in a back alley of the West Point slum on Aug. 19, 2014, in Monrovia, Liberia. Photo by John Moore/Getty Images

But imagine: You are a parent whose child has suddenly come ill with a fever. Do you cast your child away and refuse to touch him? Do you cover your face and your arms? Stay back! Unclean! Or do you comfort your child when he asks for you, arms outstretched, to make the pain go away?

Imagine: You live in a home with five other family members. Your sister falls ill, ostensibly from Ebola, but possibly from malaria, typhoid, yellow fever, or the flu. You are aware of the danger to yourself and your other family members, but you have no simple means to move her, and she is too weak to move herself. What do you do?

Imagine: You are a child of 5 years old. Your mother is sick. She implores you to back away. But you are scared. What you need, more than anything, is a hug and a cry.

Who can blame a person for this? It is a terrible, awful predicament. A moral predicament. To stay, comfort, and give love and care to those who are in desperate need, or to shuttle them off into an isolation ward, perhaps never to see them again? What an inhumane decision this is.

What makes the Ebola virus so terrifying is not its kill rate, its exponential growth, the gruesome way in which it kills, the ease of transmission, or the threat of mutation, but rather that people who care can do almost nothing but sit on the sidelines and watch.

* * *

Many have asked whether Ebola could come here, come West. (The implication, in its way, is crass—as if to suggest that we need not be concerned about a tragedy unless it poses a threat to us.) We have been reassured that it will never spread widely here, because our public health networks are too strong, our hospitals too well-stocked. The naysayers may be right about this. But they are not right that it does not pose a threat to us.

For starters, despite the pretense, the West is not immune from absurd, unscientific thinking. We have our fair share of scientific illiteracy, skepticism, ritualism, and foolishness. But beyond this, it is our similarities, not our differences, that make us vulnerable to this plague. We are human. Every mechanism we have for caring—touching, holding, feeding, playing, warming, comforting, caressing—every mechanism that we use to bind us to our families and our neighbors, is preyed upon by Ebola. We cannot seal each other into hyperbaric chambers and expect that once we emerge, the carnage will be over. We are humans, and we will care about our children and our families even if it means that we may die in doing so.

The lesson here is a vital one: People do not give up on humanity so very easily. Even if we persuade all of the population to forgo rituals like washing the dead, we will not easily persuade parents to keep from holding their sick children, children from clinging to their ailing parents, or children from playing and wrestling and slobbering all over one another. We tried to alter such behaviors with HIV/AIDS. A seemingly simple edict—“just lay off the sex with infected parties”—would seem all that is required to halt that disease. But we have learned over the decades that people do not give up sex so readily.

If you think curtailing sex is hard, love and compassion will be that much harder. Humans will never give this up—we cannot give this up, for it is fundamental to who we are. The more that medical personnel require this of people without also giving them methods to manifest care, the more care and compassion will manifest in pockets outside of quarantine. And the more humanity that manifests unchecked, the more space this virus has to grow. Unchecked humanity will seep through the cracks and barriers that we build to keep our families safe, and if left to find its own way, will carry a lethal payload.

The problem is double-edged. Ebola threatens humanity by preying on humanity. The seemingly simple solution is to destroy humanity ourselves—to seal everything off and let the disease burn out on its own. But doing so means destroying ourselves in order to save ourselves, which is no solution at all.

Photo by John Moore/Getty ImagesA medical worker in a protective suit works near Ebola patients in a Doctors Without Borders hospital on Sept. 7, 2014, in Monrovia, Liberia. Photo by Dominique Faget/AFP/Getty Images

We must find a method of caring without touching, of contacting without making contact. The physiological barriers are, for the time being, necessary. But we cannot stop people from caring about one another, so we must create, for the time being, mechanisms for caring. Since we will never be able to beat back humanity, we must coordinate humanity, at the family level, the local level, and the global level.

The only one way to battle a disease that affixes itself parasitically to our humanity is to overwhelm it with greater, stronger humanity. To immunize Africa and the rest of the world with a blast of humanity so powerful that the disease can no longer take root. What it will take to beat this virus is to turn its most powerful vehicle, our most powerful weapon, against it.

Here are some things we can do:

Donate to the great organizations that are working tirelessly to bring this disease under control. They need volunteers, medical supplies, facilities, transportation, food, etc. Share information about Ebola, so people will learn about it, know about it, and know how to address it when it comes. And inform and help others. It is natural at a time of crisis to call for sealing the borders, to build fences and walls that separate us further from outside threats. But a disease that infects humanity cannot easily be walled off in this way. Walling off just creates unprotected pockets of humanity, divisions between us and them: my family, your family; that village, this village; inside, outside.

* * *

One final thing.

When Prince Prospero, ill-fated protagonist of Edgar Allan Poe’s story “The Masque of the Red Death,” locked himself in his castle to avoid a contagion that was sweeping his country—a disease that caused “profuse bleeding at the pores”—he assumed mistakenly that the only reasonable solution to his problem was to remove himself from the scene. For months he lived lavishly, surrounded by courtiers, improvisatori, buffoons, musicians, and wine, removed from danger while the pestilence wrought havoc outside.

As with much of Poe’s writing, Prospero’s tale does not end well. For six months, all was calm. He and his courtiers enjoyed their lives, secure and isolated from the plague laying waste to the countryside. Then, one night during a masquerade ball, the Red Death snuck into the castle, hidden behind a mask and a cloak, to afflict Prospero and his revelers, dropping them one by one in the “blood-bedewed halls.” Prospero’s security was a façade, leaving darkness and decay to hold “illimitable dominion over all.” The eventual intrusion that would be his undoing foretells of a danger in believing that we can keep the world’s ills at bay by keeping our distance.

If we seek safety by shutting out the rest of the world, we are in for a brutally ugly awakening. Nature is a cruel mistress, but Ebola is her cruelest, most devious trick yet.

Benjamin Hale is associate professor of philosophy and environmental studies at the University of Colorado–Boulder. He is vice president of the International Society of Environmental Ethics and co-editor of the journal Ethics, Policy & Environment.